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Background and Objectives Tele-Savvy is a synchronous/asynchronous psychoeducation program for caregivers of community-dwelling persons living with Alzheimer’s disease and related dementias (ADRD) designed to increase caregivers’ competence and confidence (mastery) in caregiving. Its overall efficacy was tested in a randomized controlled trial. Research Design and Methods This secondary data analysis examined the caregiver mastery and psychological health (i.e., perceived stress, depressive symptoms, and burden) outcome of 153 non-Hispanic Black American and White caregivers (31 non-Hispanic Black American and 122 White caregivers) from baseline to 6 months postintervention. Given the difference in the sample sizes of Black and White caregivers, a descriptive post hoc subgroup analysis was conducted of 21 non-Hispanic Black American and 20 White adult children and grandchildren caregivers. Results In the overall sample, Black American caregivers demonstrated higher levels of mastery and lower levels of distress than White caregivers at baseline and across all time points. Over time, White caregivers, but not Black American caregivers, experienced significantly improved levels of mastery and significantly lowered levels of depression. Within the subgroup analysis, except for a moderate effect size in the management of situation scores over time among Black American adult children caregivers, similar results were obtained. Discussion and Implications The findings highlight the strengths and shortcomings of the Tele-Savvy program in improving caregiver mastery and reducing negative psychological health outcomes. Intentionally tailoring the Tele-Savvy program to certain racial and caregiving groups may hold promise in meeting the needs of more ADRD caregivers. Clinical Trial Registration NCT03033875.

Background: Posttraumatic stress disorder (PTSD) is a common sequela to military sexual trauma (MST) among women veterans. Yoga has shown promise in research examining its benefit for symptoms and sequela of PTSD. Aims: The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of Trauma Center Trauma-Sensitive Yoga (TCTSY) for women veterans with PTSD related to MST. Method: In this feasibility study, the final sample included women veterans ( n = 41) with PTSD related to MST accessing health care in a Veterans Affairs Health Care System in the southeast United States; the majority were African American ( n = 33; 80.5%). Interventions used established protocols of 10 weekly sessions of group TCTSY versus 12 weekly sessions of group Cognitive Processing Therapy (CPT). PTSD was assessed via clinical interview and participant report. Additional data collection included multiple participant-reported outcomes commonly associated with PTSD and psychophysiological measures. We also collected data regarding participant satisfaction and feasibility-related feedback from participants and providers. Results: Feasibility and acceptability were evaluated via demand, practicality, fidelity, and acceptability. This was measured by expressed interest, attendance, program completion, barriers to care and satisfaction with treatment, and satisfaction with interventions and data collection. Conclusions: Results indicate the RCT design and TCTSY implementation were feasible; a full-scale RCT was subsequently conducted to determine efficacy of the experimental intervention. Recommendations for successful research strategies are provided.

Objective: Nonpregnant individuals with diabetes mellitus (DM) or hypertension (HTN) experience greater complications of COVID-infection. Gestational DM (GDM) and hypertensive disorders of pregnancy (HDP) confer increased maternal and fetal morbidity; but whether the association of DM and HTN with COVID-illness in the non-pregnant state also exists in pregnancy is unclear. Therefore, we investigated associations between COVID-and GDM and HDP in a large urban inner-city population. Study Design: We performed a case control study among women with and without COVID-infection; controls were matched for gestational age and time of COVID-test between 3/2020 and 10/2020. Maternal demographic and clinical data including COVID-infection status were abstracted. Chi-square, logistic and linear regression were used for analysis. Results: A total of 87 women with and 9women without COVID-infection were included in the study. There was no significant association between COVID-infection and GDM (10.3% COVID positive, 9.9% COVID negative, p=0.89) . Similarly, there was no association between COVID-infection and HDP (37.9% COVID positive, 37.3% COVID negative, p=0.911) . Despite no associations between COVID-infection and GDM or HDP, subjects with COVID-infection were more likely to be obese based on pre-pregnancy BMI (p = 0.047) . Conclusions: Unlike in the non-pregnant state, COVID-infection was not significantly associated with GDM or HDP in our diverse, urban inner-city population. Our data suggest that beyond gestational metabolic dysregulation, maternal obesity alone may increase a woman’s vulnerability to COVID-infection in pregnancy. Given that the COVID-pandemic is still rampant, and that obesity affects one third of reproductive age women, future studies are essential to elucidate the mechanisms underlying this association. Disclosure A.D.Forrest: None. S.Chandrasekaran: None. M.Higgins: None. E.Ferranti: None.

Background Traditional mental health clinical experiences expose students to an environment that may not prepare them to address mental health needs in hospital settings. Purpose The purpose is of this project was to evaluate the implementation of an integrated mental health and acute care clinical model on a dedicated education unit (DEU). Methods In this pilot project, students provided dually focused medical and mental health care on assigned patients. A preclass and postclass survey measured their perceptions of mental health competency. Results There were no statistically significant differences between the 2 groups (integrated model on the DEU compared with a traditional experience on an acute care and inpatient behavioral health unit). All groups reported increased mental health competency. Conclusions Both groups showed similar improvements from the preclass to the postclass survey on perceived competence, suggesting that an integrated acute care and mental health clinical practicum may be equivalent to the traditional model.

Background Many patients are discharged with aspirin (ASA) as an anticoagulant after joint replacement surgery. In studies in which ASA was prescribed, doses were frequently missed. Adherence to postoperative ASA regimen is critical to preventing thrombotic complications. This randomized controlled study evaluated the impact of an existing medication adherence smartphone application (app) on adherence to twice daily ASA 81 mg for 35 days after knee or hip arthroplasty. Methodology Patients were randomized to either the app (intervention) group or the usual care (control) group. All patients received a baseline interview with a survey and demographics collected prior to randomization, a 36-day follow-up call for phone pill count, and a 6-week in-office interview with surveys and an in-person pill count. A convenience sample of 195 patients enrolled; 122 completed pill counts at both baseline and end of study. Ages ranged from 29 to 89 (mean: 60.4, SD: 10.1) years. The majority had a bachelor's degree or higher (59.3%), made more than $75,000 (or were retired; 51.9%), were of White race (75.9%), and female (53.8%). There were no significant demographic differences between the groups. Results There were no significant group differences in final pill counts, adherence (reasons for missed pills), or ASA Medication self-efficacy scores. However, the intervention group scored significantly higher on the ASA Adherence measure (general ease in and ability to take ASA; p = .020). Higher ASA Adherence scores were associated with lower pill counts at the end of study (better adherence) in the intervention group. There was a high rate of attrition related to failure to bring the ASA to hospital or to the follow-up appointment. Conclusions Although there were no significant differences in final pill counts between groups, the app group reported more ease in taking pills. With smartphone use virtually ubiquitous, this project provided an opportunity to educate patients and nurses about how technology can support medication adherence. It was also an excellent opportunity to involve clinical nurses in a funded research project.

The purpose of this longitudinal cohort study was to explore the outcomes of persons living with dementia (PLWD) and their caregivers during their first 9 months at the Integrated Memory Care Clinic (IMCC). IMCC advanced practice registered nurses provide dementia care and primary care simultaneously and continuously to PLWD until institutionalization. Changes were examined in caregivers' psychological well-being (perceived stress, depressive symptoms, caregiver burden, and anxiety) and health status and in PLWDs' quality of life and neuropsychiatric symptoms. Data were collected at baseline, then 3 and 6 months post-baseline. Forty-two caregivers completed all 3 assessments. Most variables remained unchanged. Statistically significant improvements in 5 sub-scales of the Neuropsychiatric Inventory were observed: caregivers' distress regarding their PLWDs' delusions and anxiety, and PLWDs' severity of delusions, depression, and total symptom severity. Further testing of the IMCC is required, including in quasi-experimental studies, to determine its efficacy.

Background Rising rates of secondary traumatic stress and burnout among nurses signal a crisis in healthcare. There is a lack of evidence regarding effective interventions to improve nurse well-being and resiliency. Purpose This study used a randomized controlled trial parallel design to test the effectiveness of a 3-hour Community Resiliency Model® (CRM) training, a novel set of sensory awareness techniques to improve emotional balance. Methods Registered nurses in two urban tertiary-care hospitals were invited to participate, which entailed attending a single 3-hour “Nurse Wellness and Well-being” class; 196 nurses consented and were randomized into the CRM intervention or nutrition education control group to determine if the CRM group would demonstrate improvement in well-being and resiliency, secondary traumatic stress, burnout, and physical symptoms. Findings Pre/post data were analyzed for 40 CRM and 37 nutrition group members. Moderate-to-large effect sizes were demonstrated in the CRM group for improved well-being, resiliency, secondary traumatic stress, and physical symptoms. Participants reported using CRM techniques for self-stabilization during stressful work events. Discussion CRM shows promise as a brief resiliency training for hospital-based nurses.

BACKGROUND: Poor adherence to hypertensive medication has been suggested to be a major contributor to uncontrolled hypertension (HTN) in African Americans. The impact that social determinants have on the various patient-level factors, including HTN beliefs, mental well-being, and social support, may provide insight into the development and tailoring of culturally targeted interventions, thus improving adherence. OBJECTIVE: The aim of this study was to examine the relationships of exposures to contextualized racial and gendered stressors, social support, and depressive symptoms with HTN illness perceptions and blood pressure (BP) medication adherence. METHODS: Participants (N = 85) were hypertensive African-American women aged 18 to 45 years (mean [SD], 39.2 [5.4] years) recruited from the community setting and outpatient medical clinics in a large metropolitan city. Hypertension illness beliefs were assessed using the 8-item Brief Illness Perception Questionnaire ("How much does your blood pressure affect your life?") and medication adherence was assessed with the 7-item Adherence to Refills and Medication Scale ("How often do you forget to take your BP medicine?"). Logistic regression analyses were performed to examine the associations with medication adherence and linear regression analyses were performed to examine the associations of continuous variables and HTN illness perceptions. RESULTS: The sample was predominantly nonadherent (81.2%). In the adjusted multivariable regression model, systolic BP (odds ratio, 0.95; P = .05) and the "Consequence" dimension of HTN beliefs (odds ratio, 0.76; P = .02) were associated with medication adherence. In the adjusted linear regression model, systolic BP (β = 0.22, P < .01) and depressive symptoms (β = 1.11, P < .01) were associated with HTN illness beliefs. CONCLUSIONS: Assessing beliefs and the mental well-being before initiating BP medications is essential for adherence and BP control.

In the operating room (OR), opaque drapes are hung between the anesthesia workstation and the operating table. Because OR teams are transient and hierarchical, social order is continuously being negotiated around this partition. We hypothesized that drape transparency, a tool for reimagining the physical and symbolic confines of the OR, might alter behavior. Due to the proximity of anesthesia providers to the drape, we examined how the drape’s transparency affected “social” and “case-related” communication between them and clinicians from surgery and nursing. We observed 58 surgical cases using an OR ethogram to document interprofessional communications (344 exchanges) involving the anesthesia provider. The effect of the type drape showed a statistically significant, GzMLM F(1, 342) = 4.924, p = .027, increase only for “social” communication. The frequency of “social” communication, known to enhance collegiality, was greater when a transparent drape was substituted for the opaque drape (34.9% vs. 21.3%, respectively).

Addiction is associated with trauma, and a body-based approach may help attenuate the long-term impacts of trauma, including addiction and mental disorders. The Community Resiliency Model® (CRM) is a novel, simple, body-based set of sensory awareness skills, which focus on “felt-sense” or interoception. We provided a single 5-h Community Resiliency Model® class in an urban drug treatment center for impoverished women in the Southeastern US. Using a pre-post mixed methods design, we collected data from 20 women on well-being, physical symptoms, anger, depression, anxiety, and spirituality. The post-test revealed that participant somatic complaints, anger, and anxiety symptoms had declined significantly, with a moderate to large effect size; well-being increased significantly, with a small effect size. Participants found the skills and concepts of CRM helpful and shared them with others. CRM is a feasible, inexpensive, and acceptable training that may be valuable for persons with addictions.

In reports of randomized controlled trials, thorough description of the attention control condition has been recommended, yet is frequently lacking. The Tele-Savvy Caregiver program for informal caregivers of persons living with dementia was tested in a randomized controlled trial with an attention control condition. The purpose of this trial was to test Tele-Savvy’s efficacy in reducing the negative effects of caregiving on caregivers, promoting quality of life for persons living with dementia, and improving caregiver mastery. We describe the design and implementation of and examine the outcomes associated with the attention control condition. Caregivers were randomized to the immediate Tele-Savvy (active condition), Healthy Living (attention control), or waitlist. The attention control content was focused on healthy lifestyle and was not intended to affect the outcomes that Tele-Savvy targeted. The attention control group was similar to Tele-Savvy in the intervention structure and duration: it consisted of seven weekly group videoconferences and 36 video lessons. Data on outcomes of caregivers and persons living with dementia were collected at baseline and three and six months post-baseline. Multilevel mixed effects models were used to determine changes in the outcomes. One hundred and eleven caregivers were randomized to the attention control condition (attrition 21.6%). Eighteen formative assessment interviews focusing on caregivers’ experience in the attention control condition were conducted. The attention control condition completers had no statistically significant changes in the variables that Tele-Savvy targeted. These results may be used in the design and implementation of attention control conditions in behavioral intervention research.

Introduction: People with HIV (PWH) are twice as likely to develop cardiovascular disease (CVD) at an average of 8 years earlier than persons without HIV independent of known risk factors; as a result, CVD is a major cause of morbidity and mortality in older PWH. Traditional CVD risk calculators do not reliably predict CVD in PWH. Psychosocial factors have been linked to higher rates of CVD in persons with and without HIV and PWH report higher rates of depression. Hypothesis: Clinical and psychosocial predictors were examined for associations with CVD risk scores among PWH. Methods: Clinical measures including blood pressure, cholesterol, CVD medications, smoking status and comorbidities were extracted from electronic medical records of PWH aged 40 years and older. CVD risk scores were calculated using the Atherosclerotic Cardiovascular Disease (ASCVD) calculator. Psychosocial factors were measured by the Perceived Stress Scale, the Internalized HIV Stigma Scale, Beck’s Depression Index-II, and the PROMIS-Sleep Disturbance and Emotional Support Scales. Multiple linear regression was used to examine associations between CVD risk scores and clinical/psychosocial variables. Covariates included age, gender, and race, and education. Results: Of the n=90 participants, the majority were male (n=52, 57.8%) and African American (n=77, 85.6%). Overall, the average CVD risk score for the total sample was low (mean 10.6, SD 7.0). Older age, which was significantly associated with higher CVD risk scores, is included in the ASCVD calculation, therefore, age was excluded from the model. Psychosocial variables and other covariates were examined with CVD risk scores and higher depressive symptom scores explained 6% of the variance (adj r 2 =0.061, p=0.01). No additional clinical or psychosocial variables were significant. Conclusions: The low ASCVD risk scores suggests that other factors such as chronic inflammation may contribute to higher CVD rates in this population and merits further research. Older age and higher depressive symptoms were significantly associated with CVD greater risk which may be bidirectional. Screening for depressive symptoms during routine clinic visits may provide a window of opportunity to reduce CVD burden in older PWH.

Introduction: Chest pain in patients with non-obstructive coronary artery disease (NO-CAD) is a major clinical problem impacting the quality of life and can present a therapeutic challenge for providers. The objective of this study was to identify clinical factors associated with chest pain frequency in NO-CAD patients. Mainly, we investigated the hypothesis that increased body mass index (BMI) and depression are associated with increased chest pain frequency in NO-CAD patients. Methods: We identified a sample of 439 patients with NO-CAD (mean age 55.3 years, 50% women, 72% white) in the Emory Cardiovascular Biobank, a database of patients who underwent coronary angiography for suspected myocardial ischemia. Sociodemographic variables, clinical risk factors like BMI, and Patient Health Questionnaire 9 (PHQ9) results - a depression screening tool - were collected. We measured chest pain frequency through a questionnaire that asked patients how many times they had chest pain, chest tightness, or angina over the preceding four weeks. Within the sample, 180 patients (41%) reported no chest pain, chest tightness, or angina, and 259 patients (69%) reported one or more instances of chest pain, chest tightness, or angina in the preceding four weeks. We compared these two groups using t-test, Mann-Whitney U test, and multivariate logistic regression analyses. Results: The sample mean BMI was 30.6 ± 6.6 kg/m 2 . The median PHQ9 score was 3.0, with scores ranging from 0 to 27 and 34% having minimal to major depressive symptoms. Compared to those with no chest pain, patients with chest pain had higher BMI (31.5 ± 7.1 vs 29.4 ± 5.6 kg/m 2 , p=0.001) and higher PHQ9 scores (median [interquartile range]: 4 [1,8] vs 1 [0,3], p Conclusions: In patients with NO-CAD, higher BMI and PHQ9 scores were associated with higher chest pain frequency. Thus, weight and depression optimization could reduce symptoms and improve quality of life in NO-CAD patients; however, this needs further study.

INTRODUCTION: Historically, stillbirth risk factors are more prevalent among non-Hispanic Black women than non-Hispanic White women, including age < 20, lower formal educational attainment, prepregnancy obesity, smoking, hypertension, diabetes, short interpregnancy interval, small for gestational age newborn, late prenatal care, and previous cesarean birth. We examined whether these disparities have changed since 2011 and identified a group of risk factors that differed between Black women and White women when accounting for correlations among variables. METHODS: In a random sample of 315 stillbirths from the National Center for Health Statistics’ 2016 fetal death data, Black women and White women were compared for each risk factor using t-tests or chi-square tests. Variables with p ≤ .20 were analyzed using multivariate analysis of variance. RESULTS: In this sample, Black women experiencing stillbirth were less likely to have a Bachelor’s degree (12.94% vs. 28.49%, p = .04), and more likely to be obese (44.5% vs. 29.1%, p = .01) than White women. Multivariate analysis accounting for correlations among variables showed a group of risk factors that differed between Black women and White women: age < 20, lower education, prepregnancy obesity, hypertension (chronic and pregnancy-associated), nulliparity before stillbirth, and earlier gestation. CLINICAL IMPLICATIONS: Less formal education, obesity, age

The electronic health records (EHR) infrastructure offers a tremendous resource for identifying controls who match the characteristics of study participants in a single-arm trial. The objectives are to (1) demonstrate the feasibility of curating a synthetic control group for an existing study cohort through EHR data extraction and (2) evaluate the effect of a lifestyle intervention on selected cardiovascular health metrics. A total of 711 university employees were recruited between 2008 and 2012 to participate in a health partner intervention to improve cardiovascular health and were followed for five years. Data of nearly 8000 eligible subjects were extracted from the EHR to create a synthetic control cohort during the same study period. To minimize confounding, crude comparison, exact matching, propensity score matching, and doubly robust estimation were used to compare the selected cardiovascular health metrics at 1 and 5 years of follow-up. Blood pressure and body mass index improved in the intervention group compared to the EHR synthetic controls. The findings of changes in lipid measurements were somewhat unexpected. When analyzing the subgroup without lipid-lowering medications, the intervention group exhibited better control of cholesterol levels over time than did our synthetic controls. Some measurements in the EHR system may be more robust for synthetic selection than others. EHR synthetic controls can provide an alternative to estimate intervention effects appropriately in single-arm studies for these measurements.

Greater family caregiver exposure to uncontrolled patient symptoms is predictive of greater caregiver psychological and physiological stress in dementia and other chronic illnesses, but these phenomena have not been well-studied in heart failure (HF) - a disease with high symptom burden. The purpose of this study was to test the hypothesis that worse patient functional status (as reflected by increasing HF symptoms) would be associated with elevated psychological and physiological stress for the caregiver. This was a secondary analysis of data from 125 HF caregivers in the Caregiver Opportunities for Optimizing Lifestyle (COOL) study. Psychological stress was measured on four dimensions: care-related strain/burden (Oberst Caregiving Burden Scale), depression (Center for Epidemiological Studies Depression Scale), anxiety (State-Trait Anxiety Index), and general stress (Perceived Stress Scale). Physiological stress was measured by markers of HPA axis function (elevated cortisol awakening response [CAR]), endothelial dysfunction (increased PAI-1), and inflammation (increased IL-6, hsCRP). HF patient functional status was quantified by caregiver assessment of New York Heart Association (NYHA) Class. Generalized linear models were used to test associations between patient NYHA Class and stress (one model per indicator). NYHA Class (ordinal) was backwards difference coded in each model to examine caregiver stress in relation to increasing levels of HF severity. Caregivers were mostly female and in their mid-fifties, with a slight majority of the sample being African American and the patient's spouse. Overall, patient functional status was associated with greater caregiver psychological and physiological stress. In terms of psychological stress, higher NYHA Class was significantly associated with greater caregiver anxiety and general stress, but not with caregiver burden or depression. In terms of physiological stress, higher NYHA Class was associated with elevated markers in all models (elevated CAR and higher IL-6, hsCRP, and PAI-1). Across models, most associations between NYHA Class and stress were present at relatively early stages of functional limitation (i.e. Class II), while others emerged when functional limitations became more severe. To inform timing and mechanisms for much-needed caregiver interventions, research is needed to determine which aspects of HF symptomatology are most stressful for caregivers across the HF trajectory.

The population of persons living with dementia (PLWDs) is increasing, although mainstream dementia care quality is suboptimal.To identify characteristics associated with: (1) PLWDs' neuropsychiatric symptoms and quality of life; and (2) distress from neuropsychiatric symptoms and well-being among their family caregivers (N = 49).Cross-sectional single-group examination of PLWD and caregivers when they enrolled into a nurse-led dementia-centered primary care clinic. Pearson correlations were run between characteristics of PLWD and caregiver and variables representing PLWD's neuropsychiatric symptoms and quality of life and their caregivers' well-being. Statistically significant correlations were reported via Cohen d statistics.Caregivers' characteristics associated with higher distress from neuropsychiatric symptoms and diminished well-being included Black race, female gender, younger age, caring for a parent with dementia, and being employed. Characteristics of PLWD associated with caregivers' higher distress and diminished well-being included longer time since dementia onset, higher Charlson Comorbidity Index, and non-Alzheimer dementia. Caregivers' characteristics associated with higher neuropsychiatric symptom burden included Black race, female gender, younger age, caring for parent PLWD, and being employed. Characteristics of PLWDs associated with higher neuropsychiatric symptom burden included non-Alzheimer dementia, longer time since dementia onset, more comorbidities, and higher Charlson Comorbidity Index. Finally, a longer time since dementia onset was associated with PLWDs' lower quality of life.Black race, caring for caring for a parent with dementia, younger age, and being employed were characteristics linked to PLWDs' higher neuropsychiatric symptom burden and caregivers' diminished well-being.Clinicians must assess and intervene with unpaid caregivers who may not appear obviously distressed.

Background Although radiation therapy (RT) has been recognized for contributing to cardiovascular disease (CVD), it is unknown whether specific doses received by cardiovascular tissues influence development. Objective In this pilot study, we examined the contribution of RT dose distribution on the development of CVD events in patients with cancer within 5 years of RT. Methods A retrospective case-controlled design was used matching 28 cases receiving thoracic RT who subsequently developed an adverse CVD event with 28 controls based upon age, gender, and cancer type. Dose volume histograms of nongated computed tomography scans received during RT characterized the dose delivered to the heart. Heart chambers were segmented using an atlas approach, and radiomics features for the segmentation as well as planning dose in each chamber were tabulated for analysis. Result No significant differences were observed in the RT dose statistics between groups, preexisting CVD, nor significant differences of RT doses delivered to distinct chambers of the heart. Cases were found to have greater CVD risk factors at the time of cancer diagnosis. Morphological significant differences for perimeter on border (P = .043), equivalent spherical radius (P = .050), and elongation (P = .038) were observed, with preexisting CVD having the highest values (ie, larger hearts). Conclusion Traditional CVD risk factors were more prevalent in the cases who developed CVD. No differences were observed in doses of RT. Of note, we observed significant differences in heart morphology and mass in known diseased hearts on the pretreatment scans. These new metrics may have implications for the measurement and quantification of CVD.

Refugee women face numerous and unique barriers to sexual and reproductive healthcare and can experience worse pregnancy-related outcomes compared with U.S.-born and other immigrant women. Community-based, culturally tailored programs like Embrace Refugee Birth Support may improve refugee access to healthcare and health outcomes, but empirical study is needed to evaluate programmatic benefits. This community-engaged research study is led by the Georgia Doula Access Working Group, including a partnership between academic researchers, Emory Decatur Hospital nurses, and Embrace. We analyzed hospital clinical records (N = 9,136) from 2016 to 2018 to assess pregnancy-related outcomes of Embrace participants (n = 113) and a comparison group of women from the same community and racial/ethnic backgrounds (n = 9,023). We controlled for race, language, maternal age, parity, insurance status, preeclampsia, and diabetes. Embrace participation was significantly associated with 48% lower odds of labor induction (OR = 0.52, p = 0.025) and 65% higher odds of exclusive breastfeeding intentions (OR = 1.65, p = 0.028). Embrace showed positive but non-significant trends for reduced cesarean delivery (OR = 0.83, p = 0.411), higher full-term gestational age (OR = 1.49, p = 0.329), and reduced low birthweight (OR = 0.77, p = 0.55). We conclude that community-based, culturally tailored pregnancy support programs like Embrace can meet the complex needs of refugee women. Additionally, community-engaged, cross-sector research approaches could ensure the inclusion of both community and clinical perspectives in research design, implementation, and dissemination.

Hypertension, a modifiable risk factor of cardiovascular disease, is largely responsible for the disproportionate morbidity and mortality in black women. Black women 20 years of age and older have a higher prevalence of HTN compared to white women (44% vs 28%). Poor adherence and non-adherence to hypertensive medications have been strongly indicated as a primary contributor to the early onset of disparity in cardiovascular disease morbidity and mortality experienced by black people. The purpose of this study was to examine medication adherence in black women relative to sociodemographic, clinical, cultural context, psychosocial, cognitive, and behavioral factors. This was a prospective, descriptive cross-sectional study of N = 85, hypertensive black women, with mean age of 39 ± 5.4 years, 18-45 years of age. Variables and measures included: sociodemographic characteristics, clinical, adverse social stressors, psychosocial, cognitive-behavioral factors, and medication adherence. Descriptive statistics, correlations, multivariate logistic regressions, and moderation analysis were tested. 81.2% (n = 69) of the sample was categorized as non-adherent. SBP was the only clinical covariate associated with HTN medication adherence. HTN illness perceptions, composite score, resilient coping, depressive symptoms, exposure to lifetime gender, and racial stressors, were not associated with HTN medication adherence. Using multivariate logistic regression, decreased SBP and lower scores on the "Consequence" dimension of the HTN illness perception scale were associated with medication adherence (χ2 = 10.53, P = .001). Adherence was associated with both the "Consequence" and "Identity" dimensions of the HTN illness perception scale indicating the need and importance for clinicians to have open and honest communication regarding HTN and its treatment in facilitating adherence.

The ability of patients to adhere to medication regimens is considered critical to achieving optimal results. Many patients are discharged with aspirin (ASA) as an anticoagulant for venous thrombosis embolism prophylaxis after joint replacement surgery. In studies where ASA was prescribed as an antithrombotic after selected orthopaedic surgeries, both lack of understanding and missing doses were identified as factors that affected adherence rates (D. , ). The purpose of this study was to explore the preliminary impact of a preset telephone alarm on medication adherence in adults prescribed ASA for 35 days after knee or hip arthroplasty. This was a randomized controlled trial (n = 79). Adherence was measured with a four-question self-reporting tool. Average age was 61 years. The majority were female (59.5%) and Caucasian (62.0%) with college or graduate degree-level education (78.5%). When comparing the groups, there were no significant differences between the two groups for the demographics of age, gender, and race. The alarm group had significantly better adherence rates, with fewer people who forgot to take their ASA; only 29.7% of the alarm group ever forgot to take their medication compared with 59.5% of the no-alarm group (p = .008). It seems that simple cell phone alarms can serve as effective reminders to patients to take selected medications as prescribed.

Purpose The purpose of this study was to describe sociodemographic, clinical, and psychosocial correlates of diabetes self-care behaviors in adults with type 2 diabetes mellitus (T2D) and comorbid heart failure (HF). Method Baseline data of 180 participants from a clinical trial that tested a 6-month integrated self-care intervention for persons with comorbid HF and T2D were analyzed. Correlational bivariate and multiple logistic regression analyses were performed to examine correlates of diabetes self-care behaviors. Result Participants had a mean age of 58 ± 11years; the majority were male (n = 118, 66%) and African American (n = 119, 66%). Number of comorbidities >2 ( P < .001), having more than a high school education ( P < .05), and African American ethnicity ( P < .05) predicted better exercise, self-monitoring blood glucose (SMBG), and foot care behaviors, respectively. The use of an aldosterone inhibitor ( P < .05) predicted worse exercise performance, higher Charlson Comorbidity Index scores ( P < .01) predicted worse SMBG, and treatment with diet plus medication ( P < .05) and dyslipidemia ( P < .001) predicted worse foot care. Conclusion Findings from this study provide new insights into the complex self-care requirements for T2D patients with comorbid HF. Integrated self-care interventions are clearly warranted in persons living with multiple chronic conditions for optimal health outcomes and the prevention of complications. Our sample of predominately African American men showed they had better T2D self-care behaviors than whites than previously reported. Additional research is needed to determine racial and gender differences on health outcomes in persons with T2D and comorbid HF.

We report the reliability, validity, and feasibility of self-performed picture pill count (PPC) as an adherence measure that was used in a randomized trial with HIV positive people living in rural Georgia. The first 61 (of 149) participants conducted an additional PPC 1–2 days after baseline. Reliability, measured by a PPC scoring instrument, analyzed participants’ ability to reproduce high quality pill count photographs free from artifact or blurring that could hamper accurate visualization of the pills and bottle labels. Except for label blur, baseline photographs (performed with coaching by study staff) and independently performed post-baseline photographs were rated as acceptable quality (> 93%). Label blur significantly worsened between the baseline and post-baseline scoring (93% vs 80%, p = 0.039), possibly indicating that participants required more education to ensure readability. Validity was determined by comparing the number of pills entered into the PC survey with the number of pills in the texted PPC; 77.5% of participants had perfectly matched pill counts (r = 0.690, p

Background African Americans are disproportionately affected by hypertension and have lower medication adherence when compared to other racial groups. Antecedent factors such as beliefs surrounding hypertension, the presence or absence of social support, and depressive symptoms have not been extensively studied collectively in relation to hypertension medication adherence in African Americans. Objective To determine the associations among demographic and clinical factors, depressive symptoms, hypertension beliefs, and social support with blood pressure medication adherence in middle-aged African American adults with a diagnosis of hypertension. Methods A cross-sectional study of (N = 120) African Americans (mean age, 49 years; 22.5% men) with a current diagnosis of metabolic syndrome, including hypertension, who reported having and taking a prescribed blood pressure-lowering medication were included. Descriptive statistics, bivariate correlation analysis, and logistic regression using odds ratio were used to examine the effects of high blood pressure beliefs, social support, and depression on medication adherence. Results A small but significant relationship was found between medication adherence and number of comorbidities (r = 0.19, P = .04). In a multivariate regression model, after controlling for gender, comorbidities remained associated with medication adherence (β = 0. 77, P = .04). Depressive symptoms, high blood pressure beliefs, and social support did not have a significant relationship with medication adherence. Conclusions Multiple comorbidities may have a positive impact upon medication adherence. Further study is needed in a larger sample of African Americans who have a diagnosis of hypertension in addition to other comorbidities requiring medication management.

Registered nurses and social workers may have little experience engaging in end-of-life discussions. Technology-assisted continuing education (TACE) improves interprofessionals' capability and comfort with these difficult discussions. This study measured the impact of TACE on improving the capability and comfort of caregivers with end-of-life communication. Comfort and capability scores increased postintervention. This was the first dual site two-discipline pilot study to explore this TACE methodology.

BACKGROUND: Front-line workers (FLW) are at risk for secondary traumatic stress, burnout, and related psychiatric sequelae: depression, anxiety, suicidality, posttraumatic stress disorder, and sleep and substance use disorders. FLW are in need of self-care programs to support their mental health. METHODS: Quasi-experimental study to assess the impact of a simple mental well-being and emotional regulation training, the Community Resiliency Model (CRM), using a convenience sample of FLW. Baseline scores of mental well-being and stress measures were compared with follow-up scores at 3 time points. Outcomes were psychological wellness (World Health Organization-5 Well-being Index); resilience (Connor-Davidson Resilience Scale-10); traumatic stress (Secondary Traumatic Stress Scale); physical symptoms (Somatic Symptom Scale-8). RESULTS: Of the 104 participants who enrolled and attended the CRM training, 73 (70.2%) completed at least 1 posttest. Well-being scores increased at 1 year with a small-moderate effect size (Cohen d=0.32). Resilience scores increased with a small-moderate effect size by 1 year (Cohen d=0.36). Secondary traumatic stress scores declined, with the largest effect at 1 week (Cohen d=0.49). Somatic symptoms decreased at each posttest, with the largest change occurring from baseline to 1 week (d=0.39). Participants reported an awareness of body sensations helped them when overwhelmed as a means of calming themselves. CONCLUSIONS: After a 3-hour CRM training, participants reported improved mental well-being and decreased secondary traumatic stress and somatic symptoms. This simple body awareness intervention may be a good resource during the COVID-19 pandemic.

Background and Objectives Family caregivers will grow in number as dementia prevalence increases, underscoring the continued importance of equipping these individuals for their new roles and ameliorating the adverse effects of caregiving. Research Design and Methods A three-armed, waitlist, randomized trial design tested Tele-Savvy, an online adaptation of a successful in-person psychoeducation program, the Savvy Caregiver. Tele-Savvy is delivered over 43 days to groups of 6–8 caregivers in 7 weekly synchronous sessions accompanied by 36 brief asynchronous video lessons. We enrolled 23 cohorts of 15 eligible caregivers (N = 261), randomized 2:2:1 to active, attention control, and usual care arms. We assessed caregiver psychological well-being and caregiving mastery at baseline and 3, 6, 9, and 12 months. Multilevel linear models assessed outcomes over the 3 time points examined. The trial was slightly truncated, with Data and Safety Monitoring Board approval, because of the apparent confounding psychological effects of coronavirus disease 2019 restrictions. Results Study findings indicate statistically and clinically significant benefits to Tele-Savvy arm caregivers (with moderate to large effect sizes) in the areas of depression, perceived stress, reaction to care recipients’ behaviors, and enhancement of caregiver mastery. Expected benefits for caregiver burden and anxiety were not found. Discussion and Implications Findings attest to program efficacy and the viability of employing distance means to improve family caregivers’ emotional well-being and sense of mastery in the caregiving role over a 6-month period. Next steps entail finding alternate ways to deliver the program to those with connectivity and/or time constraint problems.

Background Sudden cardiac arrest is a major cause of death worldwide. Performance of prompt, high-quality cardiopulmonary resuscitation improves patient outcomes. Objectives To evaluate the association between patient survival of in-hospital cardiac arrest and 2 independent variables: adherence to resuscitation guidelines and patient severity of illness, as indicated by the number of organ supportive therapies in use before cardiac arrest. Methods An observational study was conducted using prospectively collected data from a convenience sample. Cardiopulmonary arrest forms and medical records were evaluated at an academic medical center. Adherence to resuscitation guidelines was measured with the ZOLL R Series monitor/defibrillator using RescueNet Code Review software. The primary outcome was patient survival. Results Of 200 cases, 37% of compressions were in the recommended range for rate (100-120/min) and 63.9% were in range for depth. The average rate was above target 55.7% of the time. The average depth was above and below target 1.4% and 34.7% of the time, respectively. Of the 200 patients, 125 (62.5%) attained return of spontaneous circulation. Of those, 94 (47%) were alive 24 hours after resuscitation. Fifty patients (25%) were discharged from the intensive care unit alive and 47 (23.5%) were discharged from the hospital alive. Conclusions These exploratory data reveal overall survival rates similar to those found in previous studies. The number of pauses greater than 10 seconds during resuscitation was the one consistent factor that impacted survival. Despite availability of an audiovisual feedback system, rescuers continue to perform compressions that are not at optimal rate and depth.

Introduction: Multi-morbidity is increasingly recognized to negatively influence self-care behaviors such as dietary adherence in persons living with serious or life-threatening chronic conditions such as type 2 diabetes (T2D) and heart failure (HF). Aim: The aim of this study was to describe demographic, clinical, and psychosocialcorrelates of dietary self-care behaviors in adult patients with T2D and comorbid HF. Methods: The parent study for this secondary analysis was a randomized trial that tested a 6-month integrated self-care intervention for 180 participants with comorbid HF and T2D. Cross-sectional, baseline data was used for the predictive model which included demographic (age, sex, marital status, and education) psychosocial (depression [PhQ-9], self-efficacy [PDSMS], and diabetes knowledge [MDKT]); and clinical variables (years diagnosed with T2D and HF, New York Heart Association (NYHA) functional classification, Charlson comorbidity index (CCI), and implanted cardiac device). The general and specific diet components of the Summary of Diabetes Self-Care Activities (SDSCA) were used to measure dietary self-care behaviors. Correlational bivariate and stepwise linear regression analyses were performed to examine correlates of dietary self-care behaviors. Results: Participants mean age was 58 ±11 years and the majority were male (n = 118, 66%) and African American (n = 119, 66%). Charlson comorbidity >2 ( p p p p Conclusion: Findings suggest that multimorbidity may increase risk for lower diabetes dietary self-care behaviors, particularly those with more advanced HF requiring an implanted device. Future research should focus on how to promote effective self-care behaviors in persons living with multimorbidity as a strategy to improve clinical outcomes and enhance quality of life.

Introduction: The prevalence of coronary artery disease (CAD) is increasing in young adults (YA) (age Hypothesis: There will be several risk factors associated with CAD in YAs that will differ between men and women. Methods: In this secondary analysis, 125,017 YAs between the ages of 18-44 were evaluated for health conditions and behaviors considered to be risk factors for CAD. The 2017 Behavior Risk Factor Surveillance System database from the Center for Disease Control was utilized. Frequency procedures, chi-square testing, and logistic regression modeling with odds ratios were analyzed using (SAS) 9.4 software. Results: Greater percentages of men (65.5%) than women (56.7%) were found to be overweight (BMI 25-30) or obese (BMI =>30) (p2.2), high cholesterol (OR 2.2), smoking (OR 1.9), and prediabetes (OR 1.7). Physical activity (OR 0.6) and healthcare coverage (OR 0.7) were protective factors against CAD. There were 276 young adults in all who were diagnosed with CAD in this analysis. Conclusions: Greater efforts are needed to reduce the number of risk factors in YAs and prevent the development of CAD. There were significant gender differences noted in CAD risk factors within the YA population. Targeted interventions should include counseling as outlined in the American Heart Association Life’s Simple 7 Campaign in an effort to improve cardiovascular health in young adult men and women.

Background: In chronic illness caregiving, greater family caregiver exposure to patient symptoms is predictive of greater caregiver psychological and physiological stress. Although heart failure (HF) carries high symptom burden, this phenomena is not well-studied in HF caregivers. Objective: To test the hypothesis that caregiver perception of patient HF symptoms is associated with elevated caregiver psychological and physiological stress. Methods: This was a secondary analysis of baseline data from 125 HF caregivers in the Caregiver Opportunities for Optimizing Lifestyle (COOL) study. Psychological stress was measured by caregiver report of care-related strain (Oberst Caregiving Burden Scale), depression (Center for Epidemiological Studies Depression), anxiety (State-Trait Anxiety Index), and general stress (Perceived Stress Scale). Physiological stress was quantified by markers of HPA axis dysfunction (elevated cortisol awakening response [CAR]), endothelial dysfunction (increased PAI-1), and inflammation (increased IL-6, hsCRP). HF symptoms were quantified by caregiver assessment of New York Heart Association (NYHA) Class, dichotomized as asymptomatic [Class I] versus symptomatic [Class II-IV]. Generalized linear models were used to test relationships between symptoms and stress (one model per indicator). IL-6, hsCRP, and PAI-1 were natural log transformed, and CAR was dichotomized based on a cutoff for elevated stress response (>75% increase). All models controlled for sociodemographic confounders (age, gender, race, education, caregiving relationship), with biomarker-specific confounders (comorbidity, adiposity, medications) added to physiological stress models. Results: Caregivers were mostly female (n=115, 92.0%), in their mid-fifties (55.4±11.5), African American (n=72, 57.6%), and the patient’s spouse (n=68, 54.4%) or adult child (n=30, 24.0%). One quarter perceived the patient to be asymptomatic (Class I: n=31, 24.8%; II: n=31, 24.8%; III: n=47, 37.6%; IV: n=15, 12.0%). Symptomatic HF was significantly associated with greater caregiver depression, anxiety, and general stress (β=4.0±1.9, p=0.04; β=3.9±1.4, p Conclusions: Overall, patient HF symptoms were associated with greater caregiver psychological and physiological stress. To inform timing and mechanisms for much-needed caregiver interventions, research is needed to determine which aspects of HF symptomatology are most stressful for caregivers across the HF trajectory.

Background Nausea is one of the most commonly reported side effects in patients receiving chemotherapy. Patients who experience nausea during chemotherapy may also experience depression, metabolic imbalances, dehydration, decreased ability to function, and treatment delays, which can ultimately affect outcomes. Objectives This study aimed to determine the efficacy of a cool damp washcloth with peppermint essential oil versus a cool damp washcloth alone on the self-reported intensity of nausea in patients receiving chemotherapy in the outpatient ambulatory setting. Methods 79 adult patients receiving chemotherapy were recruited from an outpatient ambulatory infusion center in the southeastern United States. Patients were separated into two groups (no scent and peppermint) and asked to rate the intensity of their chemotherapy-induced nausea at pre- and postintervention using the Baxter Retching Faces pictorial scale. Findings The results demonstrated that the use of peppermint oil was effective in decreasing the intensity of nausea experienced by patients compared to a cool washcloth alone.

PURPOSE: One third of the U.S. adult population is estimated to have prediabetes. Hispanics have a 50% higher type 2 diabetes (T2DM) death rate compared to non-Hispanic whites, yet low participation in lifestyle change programs, making this subgroup an important target for prevention efforts. The purpose of this study was to determine the effects of an exercise intervention implementing the Center for Disease Control and Prevention (CDC) National Diabetes Prevention Program (NDPP) plus recreational soccer (RS) in Hispanic men. METHODS: Overweight and obese Hispanic men, aged 30–57 years with prediabetes at screening were recruited from the community. Trained soccer coaches led 30-min facilitated discussion of the NDPP modules after each RS session, with two wkly sessions delivered over 12 wks, then once a wk until 24 wks. The 1-h RS sessions followed the Football Fitness curriculum structure. Standardized study assessments included objectively measured physical activity via fitness tracker, physical fitness via validated field tests, GPS soccer specific metrics and behavior change questionnaires. Mixed models assessed the outcomes as a function of time and cohort and incorporated an unstructured covariance structure to examine the difference between baseline, 12 and 24 wks. All analyses were conducted as intent-to-treat and generated using SAS v 9.4. RESULTS: Hispanic males (n=41; mean age 41.9 [6.2 SD] years) were obese at baseline (mean BMI 32.7, standard error [0.7]). After 24 wks of the NDPP+RS intervention, there were significant beneficial changes in vertical jump (2.8 [1.3] cm; p=0.048), agility and lower extremity muscular power (figure 8-run) at 12 wks (−4.7% change; p=0.001) and 24 wks (−7.2% change; p

Background In a study of Italian heart failure patient-caregiver dyads, greater caregiver strain significantly predicted lower patient clinical event risk. Objective The purpose of this secondary analysis was to examine this relationship in a sample from the United States. Methods Data came from 92 dyads who participated in a self-care intervention. Logistic regression was used to test the relationship between baseline strain (Bakas Caregiving Outcomes Scale, divided into tertiles) and patient likelihood of events (heart failure hospitalization/emergency visit or all-cause mortality) over 8 months. Results Nearly half of patients (n = 40, 43.5%) had an event. High (vs low) caregiver strain was associated with a 92.7% event-risk reduction, but with substantial variability around the effect (odds ratio, 0.07; 95% confidence interval, 0.01–0.63; P = .02). Conclusions Although findings were similar to the Italian study, the high degree of variability and contrasting findings to other studies signal a level of complexity that warrants further investigation.

Nurse scientists are adept at translating findings from basic science into useful clinical- and community-based interventions to improve health. Over time, the focus of some nursing research has grown to include the assessment and evaluation of genomic and other output from high-throughput, or “omic,” technologies as indicators related to health and disease. To date, the growth in the application of omics technologies in nursing research has included calls to increase attention to omics in nursing school curricula and educational training opportunities, such as the Summer Genetics Institute offered by the National Institute of Nursing Research. However, there has been scant attention paid in the nursing literature to the complexity of data analysis or issues of reproducibility related to omics studies. The goals of this article are to (1) familiarize nurse scientists with tools that encourage reproducibility in omics studies, with a focus on the free and open-source data processing and analysis pipeline, and (2) provide a baseline understanding of how these tools can be used to improve collaboration and cohesion among interdisciplinary research team members. Knowledge of these tools and skill in applying them will be important for communication across disciplines and imperative for the advancement of omics research in nursing.