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Psychological symptoms, physical symptoms, and behavioral factors can affect health-related quality of life (HRQOL) through different pathways, but the relationships have not been fully tested in prior theoretical models. The purpose of this study was to examine direct and indirect relationships of demographic (age), biological/physiological (comorbidity), psychological (depressive symptoms), social (social support), physical (physical symptoms and functional status), and behavioral (dietary sodium adherence) factors to HRQOL. Data from 358 patients with heart failure were analyzed using structural equation modeling. There was a good model fit: Chi-square = 5.488, p = .241, RMSEA = .032, CFI = .998, TLI = .985, and SRMR = .018. Psychological symptoms, physical symptoms, and demographic factors were directly and indirectly associated, while behavioral and biological/physiological factors were indirectly associated with HRQOL through different pathways. Behavioral factors need to be included, and psychological factors and physical factors need to be separated in theoretical models of HRQOL.

Arterial stiffness is a precursor for the development of hypertension and premature cardiovascular disease (CVD). Physical activity has been associated with lower arterial stiffness among largely White populations, but the types of activity required and whether these findings apply to Black adults remain unknown. We examined whether physical activity levels were associated with arterial stiffness among Black adults in two independent cohorts. In the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity, 378 Black adults (age 52.8 ± 10.3, 39.7% male) without known CVD living in Atlanta, GA were recruited. Arterial stiffness was measured as pulse wave velocity (PWV). Total and domain-specific physical activity were assessed by self-report. Multiple linear regression models were used to investigate differences across physical activity levels after adjusting for age, sex, CVD risk factors, and socioeconomic status. Findings were validated in an independent cohort of Black adults ( n = 55, age 50.4 ± 9.2, 23.6% male). After adjustment for covariates, lower arterial stiffness was associated with higher self-reported levels of sport/exercise (6.92 ± 1.13 vs 7.75 ± 1.14, p < 0.001, highest vs lowest quartile) and home/life activities (7.34 ± 1.24 vs 7.73 ± 1.07, p = 0.04, highest vs lowest quartile), but not work, active living, or the overall physical activity scores. These findings were replicated in the independent cohort where higher levels of sport/exercise remained associated with lower arterial stiffness (6.66 ± 0.57 vs 8.21 ± 0.66, p < 0.001, highest vs lowest quartile). Higher levels of sport/exercise and home/life-related physical activities (in comparison to occupational physical activity) are associated with lower arterial stiffness in Black adults.

The Supplemental Nutrition Assistance Program (SNAP) provides access to healthy food for low-income individuals and households. Food security, however, does not necessarily achieve higher diet quality for beneficiaries. Diet quality is an important consideration for the development and management of chronic illness, a significant public health concern. In this study, we review incentives and disincentives implemented to improve the diet quality, the evidence on SNAP including benefits, challenges, and the politics of funding. New interventions and policies will be needed in order to improve the overall diet quality of SNAP households. SNAP should align with nutritional science to meet national public health goals. Nurses are trusted advocates for patients and the public and are uniquely positioned to aid in this effort. Informed by evidence, nurses willing to leverage their influence, can lead this needed change.

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.

BACKGROUND: Coronary artery disease (CAD) is increasing in young adults, and greater understanding of their cardiac risk factors is essential to ensure effective prevention. Given the sex differences in CAD observed in older adults, understanding sex differences in risk factors for this younger group of adults is important. Having insight of cardiac risk factors and sex differences in the young adult population is essential to creating personalized strategies for prevention in nursing care and in this age group. OBJECTIVES: The aims of this study were to determine the differences in CAD risk factors for young adult men and women and examine which factors are related to CAD early in life, ultimately to guide approaches for CAD prevention in primary care. METHODS: In this secondary analysis, 125 017 community-dwelling young adults were evaluated for health behaviors considered as risk factors for CAD. The 2017 Behavior Risk Factor Surveillance System database from the Center for Disease Control was utilized. This database contains questions asked of young adults that would help with risk management for chronic diseases like CAD. Young adults in this article were defined as being between 18 and 44 years of age. RESULTS: Men reported more cardiovascular risk factors than women and developed risk factors at an earlier age. Women had greater percentages of obesity and low activity levels. In this population, those with hypertension had the highest odds ratio for developing CAD. CONCLUSIONS: Differences between men and women in CAD risk factors included lifestyle and other chronic conditions. Greater prevention efforts should focus on these differences in young men and women to reduce risk factors and prevent the development of CAD.

Firefighters are frequently exposed to high temperatures, environmental toxicants, and strenuous physical demands. The health impacts of these occupational exposures on processes including inflammation and kidney function as well as on the gut microbiota are poorly understood. A firefighter training course may provide a controlled environment to assess these health risks.Basic health measures, stool, and blood samples were obtained from 24 firefighters participating in a one-week, heat-intensive training course. Indicators of inflammation, gut permeability, kidney health, and stool microbiota composition were measured before and after the training course in 18 participants. Urine specific gravity was measured before and after a heat-intensive training day to evaluate dehydration.The majority of firefighters in this cohort were categorized as hypertensive and experienced multiple heat-related illness symptoms during the training week and dehydration after the heat-intensive training day. While plasma IL-1β, CXCL8, and NGAL decreased over the training week, other indicators of inflammation and acute kidney injury increased, and estimated kidney function declined. Microbiota composition shifted over the course of the training week, with changes in Peptostreptococcus anaerobius and Streptococcus.This pilot study conducted in a controlled field setting suggests that the occupational environment of firefighters may increase their risk for systemic inflammation and kidney disease.

Background: Heart failure (HF) caregivers (CGs) may experience stress due to unpredictable patient disease trajectory. Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) are reported to be elevated in dementia CGs, but less is known about HF CGs response to stress or relationships with social determinants of health such as education and race. Objective: To determine if social factors (race, education) modify the relationship between patient disease severity trajectory (NYHA class) and CG stress as measured by inflammatory biomarkers of IL-6 and hs-CRP among HF CGs. Methods: A secondary analysis was conducted using baseline data from Caregiver Opportunities for Optimizing Lifestyle (COOL) trial. Education was dichotomized into technical/high school or less versus college or post-graduate degree. Race was dichotomized as African American (AA) or White/Asian due to the low number of Asian CGs. Two-way analysis of variance tests were conducted for IL-6 and hs-CRP to test interaction effects between CG perceived NYHA class and education or race. Results: Participants (n=127) were predominantly female (n=117, 92.1%), AA (n=74, 58.3 %), and the majority (70.1%) reported a college or post-graduate education. Perceived NYHA class were reported as: I (n=32, 25.6%), II (n=31, 24.8%), III (n= 47, 37.6%), and IV (n=15, 12.0%). For hs-CRP, there was a significant interaction between race and NYHA class (p=.013). Higher hs-CRP levels were noted in class II, compared to class I or class III for AA CGs (p=.004). White/Asian CGs did not have significant hs-CRP differences between NYHA classes (p=.634). While similar trends were observed for IL-6 between race and NYHA class, it did not reach statistical significance. In the model for education and perceived disease severity, NYHA class was significant (p=.038) for hs-CRP. In the post hoc test for NYHA class, hs-CRP was highest among NYHA class II (p Conclusions: Our findings suggest that CGs of AA race and/or lower education may experience higher stress earlier in the HF disease trajectory and may therefore benefit from targeted CG support interventions.

This study estimated national prevalence and trends of diagnosed and undiagnosed type 2 diabetes mellitus (T2DM) and prediabetes among heart failure (HF) patients in the U.S.This cross-sectional study included 527 participants aged 20+ years with a diagnosis of HF, using data from the National Health and Nutrition Examination Survey 2005-2016. We assessed prevalence estimates of diagnosed and undiagnosed T2DM and prediabetes stratified by age-standardized sociodemographic and health characteristics. Trends of T2DM and prediabetes prevalence were examined using logistic regressions.Prevalence rates of diagnosed and undiagnosed T2DM among HF patients were 34.7% (95% confidence interval (CI), 29.2-40.3%) and 12.8% (95% CI, 9.2-16.9%), respectively. Prediabetes affected 39.1% (95% CI, 33.6-44.9%) of HF patients. Prevalence estimates of diagnosed T2DM were significantly different between non-Hispanic White (20.1% [95% CI, 13.5-27.6%]) and Hispanic participants (52.1% [95% CI, 35.9-68.0%]) (P 0.001). The prevalence of T2DM and prediabetes did not significantly change between 2005 and 2016.Prevalence rates of T2DM and prediabetes among community-dwelling HF patients in the U.S. remained high between 2005 and 2016. Prevention of and targeted intervention for T2DM among at-risk HF patients is needed, particularly among those of Hispanic origin.

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.

Background:Early trauma (general, emotional, physical, and sexual abuse before age 18 years) has been associated with both cardiovascular disease risk and lifestyle-related risk factors for cardiovascular disease, including smoking, obesity, and physical inactivity. Despite higher prevalence, the association between early trauma and cardiovascular health (CVH) has been understudied in Black Americans, especially those from low-income backgrounds, who may be doubly vulnerable. Therefore, we investigated the association between early trauma and CVH, particularly among low-income Black Americans.Methods:We recruited 457 Black adults (age 53±10, 38% male) without known cardiovascular disease from the Atlanta, GA, metropolitan area using personalized, community-based recruitment methods. The Early Trauma Inventory was administered to assess overall early traumatic life experiences which include physical, sexual, emotional abuse, and general trauma. Our primary outcome was the American Heart Association Life’s Simple 7, which is a set of 7 CVH metrics, including 4 lifestyle-related factors (smoking, body mass index, physical activity, and diet) and three physiologically measured health factors (blood pressure, total blood cholesterol, and blood glucose). We used linear regression models adjusting for age, sex, socioeconomic status, and depression to test the association between early trauma and CVH and tested the early trauma by household income (Results:Higher levels of early trauma were associated with lower Life’s Simple 7 scores (β, −0.05 [95% CI, −0.09 to −0.01],P=0.02, per 1 unit increase in the Early Trauma Inventory score) among lower, but not higher, income Black participants (Pvalue for interaction=0.04). Subtypes of early trauma linked to Life’s Simple 7 were general trauma, emotional abuse, and sexual abuse. Exploratory analyses demonstrated that early trauma was only associated with the body mass index and smoking components of Life’s Simple 7.Conclusions:Early trauma, including general trauma, emotional abuse, and sexual abuse, may be associated with worse CVH among low-, but not higher-income Black adults.

The American Heart Association (AHA) is the largest not-for-profit funder of cardiovascular and cerebrovascular disease research in the United States. It has supported research of independent scientists for 7 decades with the goal of finding novel discoveries that will reduce death and disability from these diseases and ultimately improve overall health. In 2014, the AHA approved a pilot initiative to include lay stakeholders (patients, caregivers, and passionate advocates) in its research and science operations. The initiative was based on the premise that lay stakeholders would add a unique and necessary perspective that would improve decisions concerning research funding, research direction, and scientific guidelines. The AHA developed a framework for the initiative that defined lay stakeholder, created a volunteer recruitment and training program, established policies for incorporating lay stakeholders into science operations, and set metrics for evaluating the initiative over time. It has instituted creative ways to engage lay volunteers and to foster lay and scientist cooperation. Program assessments have been consistently positive and have identified needed future improvements. The benefits of lay/scientist collaboration have far exceeded the AHA’s expectations. The AHA will continue to strengthen lay volunteer engagement throughout its science and research operations; to focus on developing a larger, diverse group of qualified lay stakeholders; to educate scientists on how to communicate research effectively to the public and donors; and to retain the respect of donors for the rigors of its research funding, scientific statements, and clinical guidelines.

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.

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.

Background: 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.

Background Critical care nurses experience higher rates of mental distress and poor health than other nurses, adversely affecting health care quality and safety. It is not known, however, how critical care nurses’ overall health affects the occurrence of medical errors. Objective To examine the associations among critical care nurses’ physical and mental health, perception of workplace wellness support, and self-reported medical errors. Methods This survey-based study used a cross-sectional, descriptive correlational design. A random sample of 2500 members of the American Association of Critical-Care Nurses was recruited to participate in the study. The outcomes of interest were level of overall health, symptoms of depression and anxiety, stress, burnout, perceived worksite wellness support, and medical errors. Results A total of 771 critical care nurses participated in the study. Nurses in poor physical and mental health reported significantly more medical errors than nurses in better health (odds ratio [95% CI]: 1.31 [0.96-1.78] for physical health, 1.62 [1.17-2.29] for depressive symptoms). Nurses who perceived that their worksite was very supportive of their well-being were twice as likely to have better physical health (odds ratio [95% CI], 2.16 [1.33-3.52]; 55.8%). Conclusion Hospital leaders and health care systems need to prioritize the health of their nurses by resolving system issues, building wellness cultures, and providing evidence-based wellness support and programming, which will ultimately increase the quality of patient care and reduce the incidence of preventable medical errors.

Cardiovascular disease (CVD) is the number one killer of adults in the U.S., with marked ethnic/racial disparities in prevalence, risk factors, associated health behaviors, and death rates. In this study, we recruited and randomized Blacks with poor cardiovascular health in the Atlanta Metro area to receive an intervention comparing two approaches to engagement with a behavioral intervention technology for CVD. Generalized Linear Mixed Models results from a 6-month intervention indicate that 53% of all participants experienced a statistical improvement in Life’s Simple 7 (LS7), 54% in BMI, 61% in blood glucose, and 53% in systolic blood pressure. Females demonstrated a statistically significant improvement in BMI and diastolic blood pressure and a reduction in self-reported physical activity. We found no significant differences in changes in LS7 or their constituent parts but found strong evidence that health coaches can help improve overall LS7 in participants living in at-risk neighborhoods. In terms of clinical significance, our result indicates that improvements in LS7 correspond to a 7% lifetime reduction of incident CVD. Our findings suggest that technology-enabled self-management can be effective for managing selected CVD risk factors among Blacks.

Excessive daytime sleepiness is a debilitating symptom of obstructive sleep apnea (OSA) linked to cardiovascular disease, and metabolomic mechanisms underlying this relationship remain unknown. We examine whether metabolites from inflammatory and oxidative stress-related pathways that were identified in our prior work could be involved in connecting the two phenomena.This study included 57 sleepy (Epworth Sleepiness Scale (ESS) ≥ 10) and 37 non-sleepy (ESS 10) participants newly diagnosed and untreated for OSA that completed an overnight in-lab or at home sleep study who were recruited from the Emory Mechanisms of Sleepiness Symptoms Study (EMOSS). Differences in fasting blood samples of metabolites were explored in participants with sleepiness versus those without and multiple linear regression models were utilized to examine the association between metabolites and mean arterial pressure (MAP).The 24-h MAP was higher in sleepy 92.8 mmHg (8.4) as compared to non-sleepy 88.8 mmHg (8.1) individuals (P = 0.03). Although targeted metabolites were not significantly associated with MAP, when we stratified by sleepiness group, we found that sphinganine is significantly associated with MAP (Estimate = 8.7, SE = 3.7, P = 0.045) in non-sleepy patients when controlling for age, BMI, smoking status, and apnea-hypopnea index (AHI).This is the first study to evaluate the relationship of inflammation and oxidative stress related metabolites in sleepy versus non-sleepy participants with newly diagnosed OSA and their association with 24-h MAP. Our study suggests that Sphinganine is associated with 24 hour MAP in the non-sleepy participants with OSA.

Heart failure is a chronic disease punctuated by intermittent exacerbations that require hospitalization or intravenous diuretic therapy. The association of worsening heart failure events (WHFEs) with patient-centered outcomes in heart failure with reduced ejection fraction (HFrEF) remains unexplored.Patients with HFrEF completed an online survey assessing health status, medication adherence, treatment satisfaction, treatment burden, and medication costs and affordability. Patients with and without WHFEs were compared on all study variables, with adjustment for patient characteristics using linear or logistic regression. Overall, 512 patients (52.0% WHFEs) were included. Patients with WHFEs more commonly had depression (55.3% vs 24.0%), anxiety (46.2% vs 17.9%), and insomnia (77.8% vs 44.7%; P0.001 for all). Patients with WHFEs had lower adjusted mean Kansas City Cardiomyopathy Questionnaire values (52.9 vs 56.0) and Satisfaction with Medications Questionnaire values (70.5 vs 72.6) and higher Treatment Burden Questionnaire scores (51.1 vs 45.1; P0.001). Medication-related beliefs and long-term concerns were independently associated with nonadherence in patients with WHFE (adjusted odds ratios: 4.2 and 5.2, respectively; P0.01 for both). Patients with WHFE incurred 50.0% higher median monthly out-of-pocket HF prescription medication costs and less often perceived HF medications to be affordable.WHFE is associated with several adverse impacts on patients with HFrEF. Additional support is warranted to manage symptoms, comorbidities, and HF treatments to improve adherence and outcomes.

OBJECTIVE: Continuous positive airway pressure (CPAP) therapy reduces circulating intercellular adhesion molecule 1 (ICAM-1) in adults with obstructive sleep apnea (OSA). ICAM-1 levels may affect the daytime sleepiness and elevated blood pressure associated with OSA. We evaluated the association of changes frombaselineinICAM-1withchanges of objective and subjective measures of sleepiness, as well as 24-h ambulatory blood pressure monitoring (ABPM) measures, following 4 months of CPAP treatment. METHODS: The study sample included adults with newly diagnosed OSA. Plasma ICAM-1, 24-h ABPM, Epworth Sleepiness Scale (ESS), and psychomotor vigilance task (PVT) were obtained at baseline and following adequate CPAP treatment. The associations between changes in natural log ICAM-1 and changes in the number of lapses on PVT, ESS score, and 24-h mean arterial blood pressure (MAP) were assessed using multivariate regression models, controlling for a priori baseline covariates of age, sex, BMI, race, site, smoking status, physical activity, anti-hypertensive medications, AHI, and daily hours of CPAP use. RESULTS: Among 140 adults (83% men), mean (± SD) body mass index (BMI) was 31.5 ± 4.2 kg/m(2), and apnea-hyopnea index (AHI) was 36.8 ± 15.3 events/h. Sleepiness measures, although not ICAM-1 or ABPM measures, improved significantly following CPAP treatment. We observed no statistically significant associations between the change in ICAM-1 and changes in sleepiness, MAP, or other ABPM measures. CONCLUSION: Changes in ICAM-1 levels were not related to changes in sleepiness or ABPM following CPAP treatment of adults with OSA. Future work should explore whether or not other biomarkers may have a role inmediating these treatment outcomes in adults with OSA.

Background and objective: The beneficial effects of self-care include improved well-being and lower morbidity, mortality, and healthcare costs. In this article we address the current state of self-care research and propose an agenda for future research based on the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019. The vision of this Center is a world where self-care is prioritized by individuals, families, and communities and is the first line of approach in every health care encounter. The mission of the Center is to lead the self-care research endeavor, improving conceptual clarity and promoting interdisciplinary work informed by a shared vision addressing knowledge gaps. A focused research agenda can deepen our theoretical understanding of self-care and the mechanisms underlying self-care, which can contribute to the development of effective interventions that improve outcomes. Methods: During conference discussions, we identified seven major reasons why self-care is challenging, which can be grouped into the general categories of behavior change and illness related factors. We identified six specific knowledge gaps that, if addressed, may help to address these challenges: the influence of habit formation on behavior change, resilience in the face of stressful life events that interfere with self-care, the influence of culture on self-care behavioral choices, the difficulty performing self-care with multiple chronic conditions, self-care in persons with severe mental illness, and the influence of others (care partners, family, peer supporters, and healthcare professionals) on self-care. Plans to achieve results: To achieve the vision and mission of the Center, we will lead a collaborative program of research that addresses self-care knowledge gaps and improves outcomes, create a supportive international network for knowledge transfer and support of innovations in self-care research, and support and train others in self-care research. Beyond these specific short-term goals, important policy implications of this work are discussed. (c) 2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) Funding Agencies|Australian Catholic University; National Institutes of Health/National Institute for Nursing Research (NINR) [R01NR018196]; Swedish National Science Council/Swedish Research Council for Health, Working Life and Welfare (VR-FORTE); Center of Excellence for Nursing Scholarship

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.

Introduction: In patients with heart failure (IHF), health-related quality of life (HRQOL) is as important as longer survival. Deaths are inevitable for all human beings, but clinicians may help patients with HF to maintain or improve HRQOL until almost at the end of their lives. Psychological and physical symptoms can impact HRQOL through different pathways, and behavioral factors can indirectly impact HRQOL, but the relationships have not been tested in prior theoretical models. Hypothesis: Sociodemographic (i.e., age), biological/physiological (i.e., comorbidity), psycho-social (i.e., depressive symptoms and social support), physical (i.e., physical symptoms and functional status), and behavioral factors (i.e., dietary adherence) in Heo-Moser model will be associated with HRQOL directly and indirectly in patients with HF through different pathways. Methods: This is a secondary analysis of baseline data from two observational studies in which baseline data were collected using the same instruments (N = 358 patients with HF, mean age: 60.4 years). Structural equation modeling (SEM) was used to test the hypothesis. Results: In the SEM, the analysis showed desirable model fit: Chi-square = 7.710, p = .260, RMSEA = .028 (95% confidence interval = 0.00, 0.078), CFI = 0.998, TLI = 0.989, and SRMR = 0.023. Age, depressive symptoms, physical symptoms, and functional status were directly associated with HRQOL. Age, comorbidity, depressive symptoms, social support, dietary adherence, and physical symptoms were indirectly associated with HRQOL through different pathways (Figure 1). Conclusions: All the factors in the model were directly and/or indirectly associated with HRQOL through different pathways. The pathways of physical symptoms, depressive symptoms, and dietary adherence differed. This model can be used to develop interventions targeting improvement in HRQOL in patients with chronic diseases.

Introduction: Arterial stiffness is a precursor for development of hypertension and premature cardiovascular disease (CVD). Physical activity has been associated with lower arterial stiffness among largely White populations, but the types of activity required and whether these findings apply to Blacks remain unknown. We examined whether physical activity levels were associated with arterial stiffness among Blacks in two independent cohorts. Methods: In the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity, 458 Black adults (age 53 ± 10, 39% male) without known CVD living in Atlanta, GA were recruited. Arterial stiffness was measured as pulse wave velocity (PWV) using applanation tonometry (Sphygmocor Inc). Total and domain specific physical activity (work, active living, household, and sport/exercise) were assessed by self-report using the Jackson Heart Study Physical Activity Questionnaire. Multiple linear regression models were used to investigate differences after adjusting for age, gender, blood pressure, diabetes, and smoking. Change in the Framingham Risk Score (FRS) was tested as a potential mediator. Findings were validated in the Emory-Morehouse Partnership to Reduce Cardiovascular Health Disparities (META-Health) --another independent cohort of Black adults (n=60, age 50 ± 10, 25% male). Results: Lower arterial stiffness was associated with higher self-reported levels of sport/exercise (Beta = -0.54 [-1.03, -0.05], p=0.03, highest versus lowest quartile), but not work, active living, household-related physical activities, or the overall physical activity scores. 26.9% of this improvement appeared to be mediated through changes in FRS factors. These findings were confirmed in an independent group of Blacks in META-Health where higher levels of sport/exercise remained associated with lower arterial stiffness (Beta = -1.46 [-2.80, -0.12], p=0.03, highest versus lowest quartile). Conclusion: Higher sport/exercise related physical activity is associated with lower arterial stiffness in Blacks, an association that is only partially attributable to a lower traditional CVD risk factor burden.

Background: Despite well-documented cardiovascular disparities between racial groups, within-race determinants of cardiovascular health among Black adults remain understudied. Factors promoting cardiovascular resilience among Black adults in particular warrant further investigation. Our objective was to examine whether individual psychosocial resilience and neighborhood-level cardiovascular resilience were associated with better cardiovascular health in Black adults, measured utilizing Life’s Simple 7 (LS7) scores. Methods: We assessed LS7 scores in 389 Black adults (mean age, 53±10 years; 39% men) living in Atlanta, Georgia. A composite score of individual psychosocial resilience was created by assessing environmental mastery, purpose in life, optimism, resilient coping, and depressive symptoms. Neighborhood-level cardiovascular resilience was separately determined by the census tract-level rates of cardiovascular mortality/morbidity events. Generalized linear mixed regression models were used to examine the association between individual psychosocial resilience, neighborhood cardiovascular resilience, and LS7 scores. Results: Higher individual psychosocial resilience was significantly associated with higher LS7 (β=0.38 [0.16–0.59] per 1 SD) after adjustment for sociodemographic factors. Similarly, higher neighborhood-level cardiovascular resilience was significantly associated with higher LS7 (β=0.23 [0.02–0.45] per 1 SD). When jointly examined, high individual psychosocial resilience (>median) was independently associated with higher LS7 (β=0.73 [0.31–1.17]), whereas living in high-resilience neighborhoods (>median) was not. The largest difference in LS7 score was between those with high and low psychosocial resilience living in low-resilience neighborhoods (8.38 [7.90–8.86] versus 7.42 [7.04–7.79]). Conclusions: Individual psychosocial resilience in Black adults is associated with better cardiovascular health.

Over 25% of the adult population in the United States suffers from multiple chronic conditions, with numbers continuing to rise. Those with multiple chronic conditions often experience symptoms or symptom clusters that undermine their quality of life and ability to self-manage. Importantly, symptom severity in those with even the same multiple chronic conditions varies, suggesting that the mechanisms driving symptoms in patients with multiple chronic conditions are not fixed but may differ in ways that could make them amenable to targeted interventions. In this manuscript we describe at a metabolic level, the symptom experience of persons with multiple chronic conditions, including how symptoms may synergize or cluster across multiple chronic conditions to augment one’s symptom burden. To guide this discussion, we consider the metabolites and metabolic pathways known to span multiple adverse health conditions and associate with severe symptoms of fatigue, depression, and anxiety and their cluster. We also describe how severe versus mild symptoms, and their associated metabolites and metabolic pathways, may vary, depending on the presence of covariates; two of which, sex as a biological variable and the contribution of gut microbiota dysbiosis, are discussed in additional detail. Intertwining metabolomics and symptom science into nursing research, offers the unique opportunity to better understand how the metabolites and metabolic pathways affected in those with multiple chronic conditions may initiate or exacerbate symptom presence within a given individual, ultimately allowing clinicians to develop targeted interventions to improve the health quality of patients their families.

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 Cardiovascular disease incidence, prevalence, morbidity, and mortality have declined in the past several decades; however, disparities persist among subsets of the population. Notably, blacks have not experienced the same improvements on the whole as whites. Furthermore, frequent reports of relatively poorer health statistics among the black population have led to a broad assumption that black race reliably predicts relatively poorer health outcomes. However, substantial intraethnic and intraracial heterogeneity exists; moreover, individuals with similar risk factors and environmental exposures are often known to experience vastly different cardiovascular health outcomes. Thus, some individuals have good outcomes even in the presence of cardiovascular risk factors, a concept known as resilience. Methods and Results The MECA (Morehouse‐Emory Center for Health Equity) Study was designed to investigate the multilevel exposures that contribute to “resilience” in the face of risk for poor cardiovascular health among blacks in the greater Atlanta, GA, metropolitan area. We used census tract data to determine “at‐risk” and “resilient” neighborhoods with high or low prevalence of cardiovascular morbidity and mortality, based on cardiovascular death, hospitalization, and emergency department visits for blacks. More than 1400 individuals from these census tracts assented to demographic, health, and psychosocial questionnaires administered through telephone surveys. Afterwards, ≈500 individuals were recruited to enroll in a clinical study, where risk biomarkers, such as oxidative stress, and inflammatory markers, endothelial progenitor cells, metabolomic and micro RNA profiles, and subclinical vascular dysfunction were measured. In addition, comprehensive behavioral questionnaires were collected and ideal cardiovascular health metrics were assessed using the American Heart Association's Life Simple 7 measure. Last, 150 individuals with low Life Simple 7 were recruited and randomized to a behavioral mobile health (eHealth) plus health coach or eHealth only intervention and followed up for improvement. Conclusions The MECA Study is investigating socioenvironmental and individual behavioral measures that promote resilience to cardiovascular disease in blacks by assessing biological, functional, and molecular mechanisms. REGISTRATION URL : https://www.clini​caltr​ials.gov . Unique identifier: NCT 03308812.

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.

BACKGROUND: The long-term consequences of stroke affect both the carepartner (CP) and stroke survivor (SS). Understanding the effects of informal caregiving that may influence the ability of the family to carry over therapeutic activities in the home environment is critical for family-centered care. OBJECTIVE: This study examined the relationship of CP and SS factors associated with CP depressive symptoms to gain insights into CP needs that may occur after formal rehabilitation therapy has ended for SS with upper extremity deficits. METHODS: This correlational study used baseline data of 32 dyads of family CP and SS with upper extremity impairment who had completed rehabilitation therapy and were enrolled in a pilot study of a web-based CP-integrated rehabilitation program. Data using standard questionnaires for CP factors and SS memory and behavior problems and an objective assessment of SS upper extremity function were obtained. Data analysis included descriptive statistics and Pearson product moment correlations. RESULTS: CPs were female (62.5%), White (61.29%), and spouses (68.75%). CPs reported mild-moderate depressive symptoms (M = 9.5±8.3), and a majority had some degree of family conflict. Higher CP depressive symptoms were related to worse life changes (r = −0.41, p = .02), greater fatigue (r=0.50, p=.004), less effective family functioning (r=0.46, p=.01), less autonomy support to SS (r = −0.42, p = .02), and more SS memory and behavior problems (r = 0.45, p = .01). Only CP fatigue was related to SS upper extremity function. CONCLUSIONS: Negative impacts of caregiving were found in this group of relatively high physically functioning SS which may hinder CP from providing optimal support for SS. Addressing CP needs including education regarding depression, fatigue, SS memory and behavior problems, and family functioning while SS is receiving rehabilitation therapy may be important considerations to help facilitate the CP to support the SS in carrying over therapeutic activities in the home environment.

Introduction: Systemic lupus erythematosus (SLE) disproportionately affects minority women of childbearing age and is associated with increased cardiovascular risk. Understanding concomitant cardiovascular co-morbidities in the SLE population is essential to reduce their excess cardiovascular burden through targeted risk reduction. Purpose: This study examined cardiovascular co-morbidities in persons with SLE admitted to an acute care hospital. Method: We conducted a secondary data analysis of de-identified electronic health record (EHR) data from a random sample of 1,000,000 patients who received care from a healthcare system in the southeastern US between the years of 2012 and 2018. We targeted the specific patient encounter of the first hospitalization in which SLE was included as a discharge diagnosis and examined cardiovascular co-morbidities present in the cohort. Results: We identified 320 patients (89% women n=285/320, 84.4% n=270/320 African-American) with a mean age of 47.1 ± 16.4 years and length of stay (LOS) of 6.7 ± 8.1 days. The majority were hospitalized on an emergent basis (61%, n=195/320) with 44.4% (n=143/320) admitted to hospital medicine/internal medicine specialties. Admission to cardiology/cardiovascular surgery specialties was noted for 7.5% (n=27/320). The majority were discharged to home for self-care (70.9%, n=227/320) or home health services (12.5%, n=40/320). Potential SLE complications were evident with 23.7% (n=76/320) noted to have renal failure. The most common cardiovascular diagnoses documented in the EHR included: hypertension (40%, n=192/320), heart failure (18.4%, n=59/320), coronary artery disease (16.6%, n=50/320), mitral valve disorders (9.7%,n=31/320), atrial fibrillation (8.7%, n=27/320), supraventricular tachycardia (6.6%,n=21/320), acute myocardial infarction (6.2%,n=20/320), cerebral vascular accident (5.9%, n=19/320), endocarditis (4.1%,n=13/320), and peripheral vascular disease (3.7%, n=12/320). Longer LOS was associated with renal failure (r= .25, p = .001), heart failure (r= .20, p = .001), and supraventricular tachycardia (r=.22, p = .001). A greater proportion of men had endocarditis (14.3%, n=5/35), PVD (11.4%,n = 4/35), and CAD (28.6%, n=10/35) compared to women (endocarditis: 2.8%, n=8/285, p =.008; PVD 2.8%, n=8/285, p= .032; CAD 14.0% n=40/285, p=.044). Conclusion: Cardiovascular disease burden was evident in this predominantly young, female, African-American SLE inpatients. Cardiac diagnoses were associated with increased LOS and men with SLE had greater cardiovascular burden related to CAD and PVD compared to women. These findings highlight the importance of cardiovascular risk reduction interventions and aggressive management of cardiovascular comorbidities in the SLE population.

Introduction: Recent scientific statements highlight the importance of understanding the effects of the coexistence of heart failure (HF) and type 2 diabetes mellitus (T2DM) on disease management decisions and patient outcomes. Various prevalence estimates of the T2DM burden among HF patients have been reported; however, national estimates are not available. The objective of the study was to assess the prevalence and trends of T2DM (total, diagnosed, and undiagnosed) and prediabetes among community-dwelling HF patients using nationally representative data. Methods: We included 473 participants (20+ years) with a diagnosis of HF using data from the 2005-2016 NHANES survey cycles. Diagnosed T2DM was defined by self-report of a previous physician diagnosis. Undiagnosed T2DM was defined by the absence of a physician diagnosis and the presence of ≥ 1 of 3 criteria: 1) Two-hour plasma glucose (2hPG) after oral glucose tolerance test (OGTT) ≥ 200 mg/dL, 2) Hemoglobin A1c (HbA1c) ≥ 6.5%, 3) Fasting plasma glucose (FPG) ≥ 126 mg/dL. Total T2DM was defined as having diagnosed or undiagnosed T2DM. Prediabetes was defined by the absence of T2DM and the presence of ≥ 1 of 3 criteria: 1) 2hPG after OGTT of 140 mg/dL to 199 mg/dL, 2) HbA1c of 5.7% to 6.4%, 3) FPG of 100 mg/dL to 125mg/dL. We stratified estimates by age-standardized socio-demographic characteristics. Trends of the prevalence of T2DM and prediabetes were examined using logistic regressions. Results: The prevalence rates of total, diagnosed, and undiagnosed T2DM and prediabetes among HF patients were 51.4% (95% CI, 46.0%-56.7%), 37.5% (31.7%-43.6%), 13.8% (10.0%-18.2%), and 36.0% (30.2%-42.1%), respectively. The prevalence of T2DM and prediabetes did not significantly change across individual survey cycles. Conclusion: Rates of T2DM and prediabetes among community-dwelling HF patients in the U.S have been persistently high over the past decade. These findings support the need for the prevention and targeted intervention of T2DM in HF patients.

Introduction: While cardiovascular disease (CVD) morbidity and mortality is particularly pronounced among Black Americans, there is a great deal of intra-racial heterogeneity within the population. Our objective was to identify novel circulating biomarkers (extracellular miRNA and metabolites) that predict cardiovascular health (CVH) within Blacks, while providing insight into CVD pathophysiology. Hypothesis: We hypothesize that an integrative analysis of miRNA and metabolomics profiles will enable a systems biology approach to understanding CVH as defined by the American Heart Association's Life’s Simple 7 (LS7) score within Blacks. Methods: Platelet free plasma (PFP) was collected from 382 Black adults (age 53 + 10, 40% male) without known CVD living in Atlanta, GA. CVH was determined by LS7 scores calculated from measured blood pressure, blood glucose, cholesterol, body mass index (BMI), and self-reported exercise, diet, and smoking. In the discovery phase, next generation sequencing was performed on PFP samples from 20 participants with low CVH (LS7 < 6) and 20 with high CVH (LS7 > 10). DESeq was used to identify differentially expressed miRNAs. In the validation phase, RT-qPCR was used to assess levels of eight miRNAs in 382 samples. Spearman correlation and linear regression analyses were performed to assess ability of miRNA levels to predict LS7. High-resolution metabolomics profiling was performed on all 382 samples. Integrative analysis of miRNA, metabolomics profiles, and clinical domains of CVH (LS7) was performed using the program xMWAS to determine connectivity among these markers. Results: RNA sequencing identified 13 extracellular miRNAs differentially expressed between low CVH and high CVH (FDR < 0.05). Analysis of data from validation phase found the expression of four extracellular miRNAs (miRs-122, -150, -30c, -769-3p) significantly correlated with LS7. Metabolome wide association study (MWAS) identified 141 features that were differentially expressed between low and high CVH with false discovery rate of Conclusions: CVH in Blacks is associated with distinct extracellular miRNA and metabolomics profiles, and these molecular profiles are associated with pathways linked to vascular dysfunction. Integrative analysis revealed connectivity between miRNA-metabolome networks and clinical domains of CVH. This novel method represents an unique opportunity to gain insights into epigenetic and environmental influences on CVD disparities.

Introduction: Sleep is hypothesized to be a contributing factor towards disparities in cardiovascular disease (CVD). It has been demonstrated that Black Americans have worse sleep quality compared to other ethnic groups, but within group differences have not been studied. Whether overall sleep quality and patterns affect cardiovascular health (CVH) among Blacks has yet to be elucidated. Hypothesis: Black individuals reporting worse sleep quality and patterns will have poor CVH as measured by the American Heart Association’s Life’s Simple 7 (LS7) scores. Methods: We recruited 499 Black adults (age 53 ± 10, 38% male) without known CVD from the Atlanta, GA metropolitan area. Sleep quality and patterns were assessed by the Pittsburgh Sleep Quality Index (PSQI) which includes sleep quality, nighttime disturbance, efficiency (amount of time slept while in bed), daytime dysfunction, duration, need of medications and latency (time required to fall asleep). CVH was determined by LS7 scores calculated from measured blood pressure, glucose, cholesterol, body mass index (BMI), and self-reported exercise, diet, and smoking, and categorized into poor (0-8), intermediate (9-10), and ideal (11-14). Multinomial logistic regression was used to examine the relationship between sleep and the odds of intermediate (vs. poor) and ideal (vs. poor) CVH categories after adjusting for age, gender, household income, education, marital status, and employment status. Results: A total of 55 (11%), 107 (21%), and 337 (67%) participants had ideal, intermediate, and poor LS7 scores, respectively. Those reporting PSQI-assessed poor sleep quality (OR 0.50, 95% CI [0.33 - 0.78]), longer latency (OR 0.50, 95% CI [0.36 - 0.70]), disturbance (OR 0.45, 95% CI [0.26 - 0.77]) and daytime dysfunction (OR 0.52, 95% CI [0.31 - 0.89]) had significantly lower adjusted odds of having ideal CVH. Daytime dysfunction was significantly associated with lower adjusted odds of having ideal blood pressure (OR 0.57, 95% CI [0.38 - 0.87]), glucose (OR 0.71, 95% CI [0.51 - 0.98]), and physical activity (OR 0.58, 95% CI [0.36 - 0.93]). Similarly, longer latency was significantly associated with lower adjusted odds of having ideal BMI (OR 0.72, 95% CI [0.54 - 0.95]), blood pressure (OR 0.71, 95% CI [0.55 - 0.92]), and cholesterol (OR 0.73, 95% CI [0.55 - 0.98]). PSQI-assessed shorter sleep duration was not associated with poor overall CVH, but was associated with significantly lower adjusted odds of having ideal blood pressure (OR 0.77, 95% CI [0.61 - 0.99]). Conclusion: Among Black Americans, poor sleep in terms of quality, nighttime disturbance, daytime dysfunction and longer latency, was associated with worse overall CVH or its components. Whether addressing sleep quality in Blacks will improve CVH and outcomes needs to be studied.

Introduction: Early trauma (e.g. general, emotional, physical, and sexual abuse before age 18) has been associated with both cardiovascular disease (CVD) risk and lifestyle-related risk factors for CVD including smoking, obesity, and physical inactivity. However, previous studies have primarily focused on White participants, despite the fact that early trauma is more common in Blacks. In particular, the role played by low socioeconomic status (SES) in this population has been relatively understudied. Hypothesis: Black individuals reporting early trauma will have worse cardiovascular health (CVH) as measured by the American Heart Association’s Life’s Simple 7 (LS7) scores and these associations will vary by SES. Methods: We recruited 499 Black adults (age 53 ± 10, 38% male) without CVD from the Atlanta, GA metropolitan area. The Early Trauma Inventory (ETI) was administered to assess physical, sexual, emotional abuse and general trauma. CVH was determined by LS7 scores calculated from measured blood pressure, blood glucose, cholesterol, body mass index (BMI), and self-reported exercise, diet, and smoking and was categorized as poor (0-8), intermediate (9-10), and ideal (11-14). Multinomial logistic regression was used to examine the relationship between early trauma and the odds of intermediate (vs. poor) and ideal (vs. poor) CVH categories after adjusting for age, gender, household income, education, marital status, employment status, and depression. After testing for interaction between ETI and SES, stratified analysis was conducted separately on individuals with low and high SES (defined as household income less or greater than $50,000 per year, respectively). Results: A total of 55 (11%), 107 (21%), and 337 (67%) participants had ideal, intermediate, and poor LS7 scores, respectively. In the full cohort, higher levels of early trauma were associated with lower adjusted odds of ideal LS7 scores (OR 0.94, 95% CI [0.88 - 1.00] per 1 SD increase in the ETI score). In SES-stratified analyses, higher levels of early trauma (OR 0.91, 95% CI [0.84 - 0.98]), in particular emotional (OR 0.74, 95% CI [0.59 - 0.94]) and sexual abuse (OR 0.69, 95% CI [0.49 - 0.96]), were significantly associated with lower adjusted odds of ideal LS7 scores among lower, but not higher, SES Black participants (p value for interaction =0.03). Among the CVH components, emotional and sexual abuse were both associated with significantly lower adjusted odds of ideal BMI (OR 0.81, 95% CI [0.68-0.97] and OR 0.72, 95% CI [0.56-0.93], respectively) in low SES participants. Conclusion: Early trauma, particularly emotional and sexual abuse, was associated with worse CVH among Black individuals with lower SES. Further research is needed to investigate the mechanisms through which economic disadvantage potentiates the adverse influence of early trauma on CVH in Black individuals.

Background and objective The number of studies in the area of self-care is growing and international researchers are increasingly developing self-care interventions to improve outcomes of individual patients and communities. However, growth of the evidence is still slow due to challenges with designing and testing self-care interventions. In this article we address major methodological challenges with regard to the definition of self-care, use of theory, and research design, intended to provide guidance to researchers in this field. Method During the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019 we identified important issues in existing self-care research. Discussion and literature review lead to eight recommendation for future self-care research. Results In preparation, begin with a theoretically sound definition of self-care. In planning the intervention, build on and extend previous studies. Use theory to develop self-care interventions and consider translational models to guide development, evaluation and implementation of complex self-care interventions. Employ a study design that fits the current phase and objectives of the research and measure self-care and related factors carefully. In reporting, describe the sample and setting sufficiently so that others can draw conclusions about generalizability and applicability to their practice and patient population. In interpretation, describe how the intervention is assumed to work (causal assumptions) and its key components. Conclusion Our review of existing self-care research clearly illustrates that the recommendations we provide are needed if we are to substantially grow the evidence base supporting self-care. Embracing a core set of principles will allow us to build on each other's work. Tweetable abstract: A core set of methodological principles is needed to substantially grow the evidence base supporting self-care.

The aim of this study was to describe (1) nurses' physical and mental health; (2) the relationship between health and medical errors; and (3) the association between nurses' perceptions of wellness support and their health.A cross-sectional descriptive survey was conducted with 1790 nurses across the U.S.Over half of the nurses reported suboptimal physical and mental health. Approximately half of the nurses reported having medical errors in the past 5 years. Compared with nurses with better health, those with worse health were associated with 26% to 71% higher likelihood of having medical errors. There also was a significant relationship between greater perceived worksite wellness and better health.Wellness must be a high priority for health care systems to optimize health in clinicians to enhance high-quality care and decrease the odds of costly preventable medical errors.

Background Neighborhood environment is increasingly recognized as an important determinant of CVH among Black adults. Most research to date has focused on negative aspects of the neighborhood environment, with little attention being paid to the specific positive features, in particular the social environment, that promote cardiovascular resilience among Black adults. Objective We examined whether better neighborhood physical and social characteristics are associated with ideal CVH among Black adults, as measured by Life's Simple 7 (LS7) scores. Methods We recruited 392 Black adults (age 53 ± 10, 39% male) without known CV disease living in Atlanta, GA. Seven neighborhood domains were assessed via questionnaire: aesthetic quality, walking environment, safety, food access, social cohesion, activity with neighbors, and violence. CVH was determined by LS7 scores calculated from measured blood pressure, glucose, cholesterol, body mass index (BMI), and self-reported exercise, diet, and smoking, and categorized into poor (0-8), intermediate (9-10), and ideal (11-14). Multinomial logistic regression was used to examine the association between neighborhood characteristics and the odds of intermediate/ideal CVH categories compared to poor CVH after adjustment for age, gender, household income, education, marital status, and employment status. Results Better scores in the neighborhood domains of social cohesion and activity with neighbors were significantly associated with higher adjusted odds of ideal LS7 scores (OR 2.02, 95% CI [1.36 - 3.01] and 1.71 [1.20 - 2.45] per 1 standard deviation [SD] increase in respective scores). These associations were stronger for both social cohesion (OR 2.61, 95% CI [1.48 - 4.61] versus 1.40 [0.82 - 2.40]) and activity with neighbors (OR 1.82, 95% CI [1.15 - 2.86] versus 1.53 [0.84 - 2.78]) in Black women compared to men. Specifically, better scores in social cohesion were associated with higher odds of ideal CVH in exercise (OR 1.73 [1.16 - 2.59]), diet (OR 1.90 [1.11 - 3.26]), and BMI (OR 1.52 [1.09 - 2.09]); better scores in activity with neighbors were also similarly associated with higher odds of ideal CVH in exercise (OR 1.48 [1.00 - 2.19]), diet (OR 2.15 [1.23 - 3.77]), and BMI (OR 1.45 [1.07 - 1.98]; per 1 SD in respective scores). Conclusion More desirable neighborhood characteristics, particularly social cohesion and activity with neighbors, were associated with better CVH among Black adults.