Barriers and Facilitators of Self-Management for Older Adults Living With Type 2 Diabetes Mellitus: A Qualitative Study in China.

PURPOSE: The purpose of the study was to explore the barriers to and facilitators of self-management among older adults with type 2 diabetes mellitus (T2DM). METHODS: This study followed a qualitative descriptive methodology. Older adults with T2DM living in Jinan, Shandong Province, China were recruited using purposive sampling. Information saturation was used to gauge the sample size. Semistructured interviews were conducted with 23 participants. The data analysis was guided using a thematic approach. Themes were inducted from the interview data undergirded by the cumulative complexity model. RESULTS: The key findings of this study are presented in terms of 2 themes: facilitators of T2DM self-management and barriers to T2DM self-management. Each theme has subthemes, including that having family members with diabetes, having family members who are health care professionals, and visual cues were factors for good self-management practices by older adults with T2DM. Conversely, poor health status (ie, multimorbidity and lower-limb dysfunction and pain) and intergenerational care responsibilities were identified as barriers to effective self-management. Moreover, the use of media resources, especially traditional media, was found to both assist and hinder participants in their self-management practices. CONCLUSION: The findings from this study can inform new research to build on existing self-management promotion programs and restructure existing services to improve the self-management of older adults with T2DM. With the increase in the number and types of media outlets, our finding implies that researchers or clinical practitioners may develop strategies to leverage media resources to enhance the self-management of diabetes among older adults with T2DM.

Turning the Health Equity Lens to Diversity in Asian American Health Profiles.

The monolithic misrepresentation of Asian American (AsAm) populations has maintained assumptions that AsAm people are not burdened by health disparities and social and economic inequities. However, the story is more nuanced. We critically review AsAm health research to present knowledge of AsAm health profiles from the past two decades and present findings and opportunities across three topical domains: (a) general descriptive knowledge, (b) factors affecting health care uptake, and (c) effective interventions. Much of the literature emphasized underutilization of health care services; low knowledge and awareness among AsAms about health-related risk factors, prevention, diagnosis, and treatment; inadequate efforts by health systems to improve language access, provider-patient communication, and trust; and the critical roles of community- and faith-based organizations and leaders in health promotion initiatives. Future opportunities for AsAm health research will require adoption of and significant investment in community-engaged research infrastructure to increase representation, funding, and research innovation for AsAm communities.

Short-Form Video Exposure and Its Two-Sided Effect on the Physical Activity of Older Community Women in China: Secondary Data Analysis.

Background: There is a tendency for older adults to become more physically inactive, especially older women. Physical inactivity has been exacerbated since the COVID-19 pandemic. Lockdowns and information-based preventive measures for COVID-19 increased the number of short-form video app users and short-form video exposure, including content exposure and the duration of exposure, which has demonstrated important effects on youths' health and health-related behaviors. Despite more older adults viewing short-form videos, less is known about the status of their short-form video exposure or the impacts of the exposure on their physical activity. Objective: This study aims to describe physical activity-related content exposure among older adults and to quantify its impacts along with the duration of short-form video exposure on step counts, low-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Methods: We analyzed a subsample (N=476) of older women who used smartphones and installed short-form video apps, using the baseline data collected from an ongoing cohort study named the Physical Activity and Health in Older Women Study (PAHIOWS) launched from March to June 2021 in Yantai, Shandong Province, China. The information on short-form video exposure was collected by unstructured questions; physical activity-related content exposure was finalized by professionals using the Q-methodology, and the duration of exposure was transformed into hours per day. Step counts, LPA, and MVPA were assessed with ActiGraph wGT3X-BT accelerometers. Multiple subjective and objective covariates were assessed. Linear regression models were used to test the effects of short-form video exposure on step counts, LPA, and MVPA. MVPA was dichotomized into less than 150 minutes per week and 150 minutes or more per week, and the binary logistic regression model was run to test the effects of short-form video exposure on the achievement of spending 150 minutes or more on MVPA. Results: Of 476 older women (mean age 64.63, SD 2.90 years), 23.7% (113/476) were exposed to physical activity-related short-form videos, and their daily exposure to short-form videos was 1.5 hours. Physical activity-related content exposure increased the minutes spent on MVPA by older women (B=4.14, 95% CI 0.13-8.15); the longer duration of short-form video exposure was associated with a reduced step count (B=-322.58, 95% CI -500.24 to -144.92) and minutes engaged in LPA (B=-6.95, 95% CI -12.19 to -1.71) and MVPA (B=-1.56, 95% CI -2.82 to -0.29). Neither content exposure nor the duration of exposure significantly increased or decreased the odds of older women engaging in MVPA for 150 minutes or more per week. Conclusions: Short-form video exposure has both positive and negative impacts on the physical activity of older adults. Efforts are needed to develop strategies to leverage the benefits while avoiding the harms of short-form videos.

The application of clique percolation method in health disparities research.

AIMS: Clique percolation, one of the joint community detection algorithms in network science, is a novel and efficient approach to detecting overlapping communities in real networks. The current study illustrated how clique percolation can help to identify overlapping communities within the complex networks underlying health disparities, particularly highlighting nodes with strong associations with more than one community. DESIGN: A cross-sectional study. METHODS: The study used a dataset on Latinx populations (N = 1654; mean age = 43.3 years; 53.1% women) as an example to demonstrate the role of such overlapping nodes in the network of syndemic conditions and their common risk factors. Syndemic conditions in the network included HIV risk, substance abuse (smoking, heavy alcohol consumption and marijuana use) and poor mental health. Moreover, the risk factors encompassed individual (education and income) and sociostructural (adverse childhood experiences [ACEs] and access to services) factors. The network was estimated using the R-package bootnet. Clique percolation was conducted on the estimated network using the R-package CliquePercolation. RESULTS: A total of three communities were detected, with HIV risk and poor mental health not being assigned to any community. In general, Community 1 was comprised of ACE categories, Community 2 included education, income and access to services and Community 3 included other syndemic conditions. Of note, two nodes were assigned to two communities: 'household dysfunction' to Communities 1 and 2 and 'smoking' to Communities 2 and 3. CONCLUSION: Household dysfunction might be the key connector, among other ACEs, to individual and structural barriers. Such barriers further exposed Latinx individuals to risky behaviours, especially smoking, which further linked to marijuana use and heavy alcohol consumption. IMPACT: Clique percolation facilitated our understanding of the complex systems of factors shaping health disparities. The overlapping nodes are promising intervention targets for reducing health disparities in this historically marginalized population. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Network analysis of adverse childhood experiences and cardiovascular diseases.

Significance: The findings to date indicate that adverse childhood experiences (ACEs) increase the risk of cardiovascular disease (CVD) in later life. We demonstrate how network analysis, a statistical method that estimates complex patterns of associations between variables, can be used to model ACEs and CVD. The main goal is to explore the differential impacts of ACE components on CVD outcomes, conditioned on other ACEs and important covariates using network analysis. We also sought to determine which ACEs are most synergistically correlated and subsequently cluster together to affect CVD risk. Methods: Our analysis was based on cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System, which included 31,242 adults aged 55 or older (54.6% women, 79.8% whites, mean age of 68.7 ± 7.85 years). CVD outcomes included angina/coronary heart disease (CHD) and stroke prevalence. Mixed graphical models were estimated using the R-package mgm, including all variables simultaneously to elucidate their one-to-one inter-relationships. Next, we conducted Walktrap cluster detection on the estimated networks using the R-package igraph. All analyses were stratified by gender to examine group differences. Results: In the network for men, the variable "household incarceration" was most strongly associated with stroke. For women, the strongest connection was between "physical abuse" and stroke, followed by "sexual abuse" and angina/CHD. For men, angina/CHD and stroke were clustered with several CVD risk factors, including depressive disorder, diabetes, obesity, physical activity, and smoking, and further clustered with components of household dysfunction (household substance abuse, household incarceration, and parental separation/divorce). No clusters emerged for women. Conclusions: Specific ACEs associated with CVDs across gender may be focal points for targeted interventions. Additionally, findings from the clustering method (especially for men) may provide researchers with valuable information on potential mechanisms linking ACEs with cardiovascular health, in which household dysfunction plays a critical role.

Risk and Protective Factors Associated With Intimate Partner Violence Against Chinese Women: A Systematic Review.

Intimate partner violence (IPV) is a global health challenge leading to various detrimental health outcomes. Chinese women are a vulnerable population often overlooked in IPV research. Guided by the social-ecological model, this systematic review aims to synthesize literature on the risk and protective factors for IPV among Chinese women. A comprehensive search was conducted in nine major English and Chinese databases for articles with data collected since 2006 on adult Chinese women, leading to 29 papers in the final analysis. Risk and protective factors associated with IPV identified in this review include factors at the individual level such as demographics (e.g., a younger age, unplanned pregnancy, abortion, having children, and migration), socioeconomic status (e.g., income and partners' education level), attitudinal factors (e.g., attitudes justifying IPV and traditional beliefs about gender roles), behavioral factors (e.g., alcohol use of women, partners' alcohol use and frequency, and partners' high frequency of gambling), adverse childhood experiences (e.g., witnessed violence in childhood), and other personal characteristics (e.g., chronic illness and good health status). Factors at the relationship level include conflicts, power in intimate relationships, and social capital (e.g., the size of social networks, network participation of women and their partners, and social control). Community-level factors related to geographic locations were also explored while no factors were identified at the societal level. None of the included studies examined the intersections of factors within the same level or across different levels. Recommendations for future research, practice, and policy are also discussed.

Trapped in My Roles as a Woman With No Help: Experiences of Intimate Partner Violence Against Chinese Women.

An understanding of intimate partner violence (IPV) experiences is a crucial first step toward shaping effective responses. However, relevant knowledge among Chinese women is scant. This study described Chinese women's IPV experiences by analyzing 46 posts shared by 42 women on a public online forum. Five overarching themes were identified using conventional qualitative content analysis: being trapped in my roles, no power in the relationship, the struggles are real but I need to tolerate, I want to leave but have no help, and hope for the future. This study has important implications for future research, practice, and education.

Acculturation, Acculturative Stress, Adverse Childhood Experiences, and Intimate Partner Violence Among Latinx Immigrants in the US.

Latinx immigrants bear a disproportionate burden associated with intimate partner violence (IPV); however, efforts to develop evidence-based IPV prevention strategies and address health disparities have been impeded by a lack of understanding of the unique cultural (i.e., acculturation and acculturative stress) and socio-environmental (i.e., adverse childhood experiences [ACEs]) factors that contribute to IPV in this historically marginalized population. Guided by a contextual framework for IPV and a life-course perspective viewed through a gendered lens, this study aims to (a) identify relationships among acculturation, acculturative stress, ACEs, and IPV victimization and perpetration; and (b) explore whether profiles of IPV risk factors differ by gender (women vs. men) among Latinx immigrants. This cross-sectional, descriptive, correlational study was a secondary analysis of data from the baseline assessment of 331 ever-partnered Latinx immigrants aged 18 to 44 in a longitudinal study named Salud (Health), Estrés (Stress), y Resilencia (Resilency) (SER) Hispano. Logistic regressions adjusting for individual characteristics and gender subgroup analyses were used to address study aims. The majority of the participants were women (71.30%). More than half of all participants had experienced IPV victimization (57.70%) or IPV perpetration (60.73%). Latinx immigrants with higher family stress (adjusted odds ratio [aOR] = 1.16; p < .001) had an elevated risk for IPV victimization; those with more ACEs (aOR = 1.08; p = .005) had an increased risk for IPV perpetration. Women had a lower risk of IPV victimization (aOR = 0.45; p = .03) and a higher risk for IPV perpetration (aOR = 3.26; p = .001) compared to men. Although further research is warranted, the profiles of risk factors for IPV perpetration were different for women than for men. Culturally tailored preventions focused on acculturative stress and ACEs are needed to help Latinx immigrant communities minimize exposure to life-course adversities, improve positive adaptation to the US, and eliminate IPV-relevant health disparities.

The #StopAsianHate Movement on Twitter: A Qualitative Descriptive Study.

Evidence-based intervention and policy strategies to address the recent surge of race-motivated hate crimes and other forms of racism against Asian Americans are essential; however, such efforts have been impeded by a lack of empirical knowledge, e.g., about racism, specifically aimed at the Asian American population. Our qualitative descriptive study sought to fill this gap by using a data-mining approach to examine the contents of tweets having the hashtag #StopAsianHate. We collected tweets during a two-week time frame starting on 20 May 2021, when President Joe Biden signed the COVID-19 Hate Crimes Act. Screening of the 31,665 tweets collected revealed that a total of 904 tweets were eligible for thematic analysis. Our analysis revealed five themes: "Asian hate is not new", "Address the harm of racism", "Get involved in #StopAsianHate", "Appreciate the Asian American and Pacific Islander (AAPI) community's culture, history, and contributions" and "Increase the visibility of the AAPI community." Lessons learned from our findings can serve as a foundation for evidence-based strategies to address racism against Asian Americans both locally and globally.

The impact of a maternal mental health intervention on intimate partner violence in Northern Ghana and the mediating roles of social support and couple communication: secondary analysis of a cluster randomized controlled trial.

BACKGROUNDS: Diverse intervention efforts are implemented to address intimate partner violence (IPV) against women. Via a syndemics theory lens and emerging empirical evidence, mental health interventions demonstrate promise to partially ameliorate IPV. However, the mechanisms of change underlying many IPV interventions are not well understood. These gaps impede our efforts to strengthen or integrate effective components into the current mental health resources, especially in low- and middle-income countries (LMICs). This study aims to examine the impact of a maternal mental health intervention called Integrated Mothers and Babies Course & Early Childhood Development (iMBC/ECD) on IPV and whether social support and/or couple communication mediates the intervention effects among women in rural, Northern Ghana. METHODS: The current study is a secondary data analysis of a cluster randomized controlled trial. IPV was measured at baseline and 8 months post-intervention (~ 19 months post-baseline). At baseline, 84.8% of the women enrolled in the study (n = 374) reported some type of IPV in the past 12 months. Logistic regression models and multiple mediation analyses were used to address the study aims. RESULTS: iMBC/ECD did not reduce IPV in the intervention group compared to the control group. Social support and couple communication did not mediate the intervention effects on IPV as indicated by the indirect effects of the multiple mediation models. However, increase in social support reduced women's odds of experiencing emotional violence by 7%, odds ratio (OR) = 0.93, p = 0.007; b = - 0.07, 95% confidence interval (CI) = (- 0.13, - 0.02), and improvement in couple communication demonstrated promise in reducing women's odds of experiencing controlling behaviors by 7%, OR = 0.93, p = 0.07; b = - 0.07, CI = (- 0.14, 0.005), though the improvements were not due to the intervention. CONCLUSION: This maternal mental health intervention did not reduce IPV; however, the findings extend our knowledge about the impact of such interventions on IPV and the potential mechanisms of change via social support and couple communication. Future research evaluating the impact of mental health interventions on IPV and mechanisms of change is essential for the development of effective interventions. Future programs addressing IPV in LMICs should consider risk factors beyond relationship level (e.g. poverty and gender inequity). TRIAL REGISTRATION: ClinicalTrials.gov # NCT03665246 , Registered on August 20th, 2018.

Symptom Trajectory among Formerly Abused Women: An Exploratory Study.

Women who have experienced intimate partner violence suffer from symptoms that persist long after the abuse has ended. However, the patterns and trajectory of these symptoms are poorly understood. The objective of this longitudinal research was to explore symptom trajectory typologies. A latent class growth analysis with multi-outcomes modeling was used to explore typologies based on women's (N = 30) trajectories over 4 months. Two distinct symptom typologies were identified: (1) consistently lessening symptom group (n = 16); (2) moderately worsening symptom group (n = 14). Women who experienced severe psychological vulnerability exhibited better symptom trajectories; a potential reflection of resilience in this population.

Applying a Nursing Perspective to Address the Challenges Experienced by Cisgender Women in the HIV Status Neutral Care Continuum: A Review of the Literature.

ABSTRACT: The field of HIV research has grown over the past 40 years, but there remains an urgent need to address challenges that cisgender women living in the United States experience in the HIV neutral status care continuum, particularly among women such as Black women, who continue to be disproportionately burdened by HIV due to multiple levels of systemic oppression. We used a social ecological framework to provide a detailed review of the risk factors that drive the women's HIV epidemic. By presenting examples of effective approaches, best clinical practices, and identifying existing research gaps in three major categories (behavioral, biomedical, and structural), we provide an overview of the current state of research on HIV prevention among women. To illustrate a nursing viewpoint and take into account the diverse life experiences of women, we provide guidance to strengthen current HIV prevention programs. Future research should examine combined approaches for HIV prevention, and policies should be tailored to ensure that women receive effective services that are evidence-based and which they perceive as important to their lives.

Abstinence Following a Motivation-Skill-Desensitization-Mental Energy Intervention for Heroin Dependence: A Three-year Follow-up Result of a Randomized Controlled Trial.

The high rate of relapse among heroin users remains a significant public concern in China. In the present study, we utilized a Motivation-Skill-Desensitization-Mental Energy (MSDE) intervention and evaluated its effects on abstinence and mental health. Eighty-nine male heroin users in a drug rehabilitation center were enrolled in the study. The participants in the MSDE intervention group (n=46) received MSDE intervention, which included motivational interviewing, coping skills training, eye movement desensitization and reprocessing, and mindfulness-based psychotherapy. The participants in the control group (n=43) received a series of lectures on skills training. A significant increase in Contemplation Ladder score (P<0.001) and decreases in scores on the Obsessive Compulsive Drug Use Scale (P<0.001), Beck Depression Inventory (P<0.001), and Aggression Questionnaire (P=0.033) were found immediately after intervention. Compared to the control group, the MSDE intervention group reported significantly higher abstinence rates (P=0.027) and retention rates (P<0.001) at follow-up. Overall, the MSDE intervention, which uses a combined strategy for relapse prevention, could be a promising approach for preventing relapse among heroin users in China.

Chinese Physicians' Perspectives on the 2017 American College of Cardiology/American Heart Association Hypertension Guideline: A Mobile App-Based Survey.

INTRODUCTION: Hypertension is a leading global risk factor for death and disability. Seeking new ways to prevent and treat hypertension is a priority for scientists and healthcare professionals worldwide. In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued a new hypertension guideline shifting the definition of hypertension from 140/90 mm Hg to 130/80 mm Hg for systolic/diastolic blood pressure. This new diagnostic threshold of hypertension has sparked a lively discussion worldwide over whether it should be applied in clinical settings to diagnose and treat hypertension. China, the world's most populous country, is facing a hypertension crisis. According to the 140/90 mm Hg guideline, China has an estimated 244.5 million population aged ≥ 18 years with hypertension, and another 435.3 million with pre-hypertension. If the new guideline is adopted, the prevalence of hypertension in China would double. This change would significantly impact patients, healthcare professionals, scientists, and policy makers in terms of the delivery of care and needed resources. AIM: This study aims to investigate whether Chinese physicians will use the 130/80 mm Hg threshold to diagnose hypertension in clinical practice. METHODS: In March 2018, we launched a mobile app-based survey to study 253 Chinese physicians' perspectives on the ACC/AHA Guideline. RESULTS: A total of 253 physicians from 21 Chinese provinces completed the survey. Nearly 80% of the participants had already noticed the ACC/AHA guideline change. The proportion of participants who said they would use the new threshold to diagnoses hypertension was 41%, while 59% said they would not use the new threshold. The primary reason for those who said "yes" was that they believed early diagnosis of hypertension can trigger early actions to prevent the increasing blood pressure. For those who said "no", they argued that their decision was based on the fact that the Chinese Hypertension Prevention Guideline had not yet changed the diagnostic threshold from 140/90 to 130/80 mm Hg. CONCLUSIONS: Different understanding of hypertension prevention and treatment exists among Chinese physicians. It is an emergent need to form an evidence-based authoritative answer to guide Chinese physicians' future clinical practice.

A New Measure for Assessing the Intensity of Addiction Memory in Illicit Drug Users: The Addiction Memory Intensity Scale.

Disrupting the process of memory reconsolidation could be a promising treatment for addiction. However, its application may be constrained by the intensity of addiction memory. This study aimed to develop and initially validate a new measure, the Addiction Memory Intensity Scale (AMIS), for assessing the intensity of addiction memory in illicit drug users. Two studies were conducted in China for item analysis (n = 345) and initial validation (n = 1550) of the AMIS. The nine-item AMIS was found to have two factors (labelled Visual Clarity and Other Sensory Intensity), which accounted for 64.11% of the total variance. The two-factor structure provided a reasonable fit for sample data and was invariant across groups of different genders and different primary drugs of use. Significant correlations were found between scores on the AMIS and the measures of craving. The AMIS and its factors showed good internal consistency (Cronbach's α: 0.72⁻0.89) and test-retest reliability (r: 0.72⁻0.80). These results suggest that the AMIS, which demonstrates an advantage as it is brief and easy to administer, is a reliable and valid tool for measuring the intensity of addiction memory in illicit drug users, and has the potential to be useful in future clinical research.

Nonmedical Use of Cough Syrup Among Secondary Vocational School Students: A National Survey in China.

Nonmedical use of cough syrup (NUCS) among secondary vocational school (SVS) students has been an increasing concern for public health in China, but no data were available. This cross-sectional study aimed to investigate the epidemiological characters of NUCS as well as its risk factors among SVS students in China.From September 2013 to December 2014, a total of 13,614 SVS students were purposively selected through multistage sampling in 6 cities of China. Information on NUCS, demographics, family background, smoking and alcohol consumption, impulsiveness, sensation seeking, and parental monitoring were collected. Logistic regression was used to explore factors related to NUCS.The 12,923 (94.9%) valid responses (16.3 ±â€Š1.0 years old, and 52.6% men) reported 3.47% (95% confidence interval: 3.15-3.79%) lifetime NUCS. Logistic regression indicated that smoking, part-time job experience, high level of impulsiveness, and sensation seeking were risk factors for NUCS, whereas urban living and high parental monitoring were protective ones.NUCS was prevalent among SVS students. Interventions that target on smoking, impulsiveness and sensation seeking control, improvement on parental monitoring may have considerable impact on NUCS among SVS students.