Associations of animal source foods, cardiovascular disease history, and health behaviors from the national health and nutrition examination survey: 2013-2016.

Background: Some individuals adopt vegetarian or plant-based diets to improve their health. Observational evidence suggests diets composed of higher amounts of animal-source foods (ASFs) are associated with increased risk for disease and early mortality. In many of these studies, those who ate fewer animal-source foods reported fewer disease risk factors and unhealthy behaviors, which could indicate bias. Purpose: This study aims to examine the relationships between ASF consumption, health behaviors, and cardiovascular disease (CVD) prevalence in a population-representative sample of U.S. civilians controlling for confounders. Methods: Respondent data were collected from the National Health and Nutrition Examination Survey (NHANES) 2013-2016 collection years. Collected data included demographics, ASF intake, healthy lifestyle variables, body mass index, and blood lipids. Results: There was a higher proportion of those with CVD history who consumed red meat (61.3%; C.I. 41.7%-77.8%), but the proportion was lower for white (23.3%; C.I. 12.6%-39.0%) and processed meat (15.4%; C.I. 6.5%-32.3%). When adjusted for sex, the odds of CVD history increased for red meat compared to processed meat consumption (OR 2.95; C.I. 1.14-7.66). Unhealthy lifestyle increased the odds of CVD history by nearly 8-fold (OR 7.8; C.I. 3.44-17.7). Individual factors including age, smoking history, body mass index, and blood lipids, and demographic factors, including education level, race, and income, were also associated with increased odds for CVD history. ROC analysis revealed 77.2% AUC for CVD history classified by individual factors (BMI ≥30 kg/m**2, ≤ 30 min moderate physical activity, smoker, fiber intake ≤25 g, dental visit more than two years ago, and age above 60 years). Three or more factors moderately predicted CVD history when optimized for sensitivity (73.4%) and specificity (71%). Adjusted for sex, the relationship between CVD and moderate physical activity became stronger possibly reflecting lifestyle changes. Despite evidence of lifestyle changes, modifiable risk factors persisted in the CVD group. CVD diagnosis in males was substantially delayed compared to females concerning the sex-specific age cutoff associated with higher risk. The healthy lifestyle group was characterized by earlier CVD diagnosis and fewer overall risk factors compared to the unhealthy lifestyle group. Conclusion: CVD history was strongly associated with demographic, lifestyle, and dietary factors. Future research should focus on multidimensional models for disease risk stratification and prevention, including individual, behavioral, and sociodemographic factors.

Energy Drink Use in Adolescents With and Without ADHD: Trends and Influences.

OBJECTIVE: We sought to determine the frequency, reasons for, and factors associated with energy drink consumption in adolescents with or without attention deficit hyperactivity disorder (ADHD). DESIGN: Anonymous surveys were completed by 115 adolescents and their parents prior to appointments at two separate outpatient clinics (pediatric and psychiatric) over a three-month period. Trained staff provided surveys to be completed by adolescents and their parents on a voluntary basis, and all data was self-reported. Care was given to ensure adolescents and their parents completed surveys independently from each other. RESULTS: A total of 114 adolescent surveys and 100 parent surveys were included in analysis. There was a statistically significant association between parent and adolescent consumption of energy drinks. The mean number of energy drinks consumed in the past month was lower among adolescents than among parents. The most common reason among all respondents for energy drink consumption was to promote wakefulness. CONCLUSION: This survey found that adolescents with parents who consumed energy drinks were more likely to drink energy drinks themselves. Trends indicate that consumption of energy drinks is increasing in the adolescent population, with potential for serious adverse events resulting from high caffeine content, warranting the need for public health awareness.

Occupational Therapy in Haiti: A Pilot Study to Identify Intervention Methods Used during Short-Term Medical Missions.

Due to the shortage of occupational therapists (OTs) in Haiti and over 800,000 individuals with disabilities, most occupational therapy assessments and interventions are provided by OTs on short-term medical missions (STMMs). Learning which methods OT use to provide assessments and interventions during these STMMs is the first step to understanding how to facilitate follow-up and carry-over for clients and ensure longevity for STMMs in Haiti. This study used a cross-sectional, descriptive design to gather data on methods used by OTs. Thirty-three OTs, who travelled to Haiti on STMMs, completed a 16-question, online survey. The most common method provided by OTs was education to patients, caregivers, and local providers. Training of Haitian rehabilitation technicians was also prevalent. There was an association between the years of the OTs' clinical experience and the effort of OTs to train local providers, but this result was not statistically significant. Further research should be implemented on specific methods that can be used in the absence or shortage of Haitian OTs to ensure follow-up for Haitian clients. The sharing of data regarding OT methods on STMMs will promote evidence-based, client-centered, and cost-effective therapy to enhance effective client outcomes.

Pharmacovigilance Assessment of Cardiac Implications of Nicotine Replacement Therapy Among Smokers.

PURPOSE: The purpose of this quantitative comparative study was to examine the possible relationship between nicotine replacement therapy (NRT) and cardiac disorder risk by comparing the rates of cardiac disorder risk of NRT with cardiac disorder risk of non-replacement drugs among smokers seeking smoking cessation. METHODS: The study used retrospective quantitative design, which involved the collection of secondary data from the adverse event reporting system (FAERS) database of the U.S Food and Drug Administration (FDA). Rates of cardiac disorder were compared between the NRT group and non- NRT (varenicline and bupropion) group. Statistical analyses involved using a 2x2 contingency table and logistic regression to calculate odds ratio (reporting odds ratio (ROR)). RESULTS AND DISCUSSION: Unadjusted ROR was 0.45 (95% confidence interval [CI] 0.28, 0.70). With age and sex as confounding factors, the smokers in the NRT group still had lower odds of having cardiac disorder risk than the non-NRT group (adjusted ROR=0.44, 95% CI 0.28, 0.70). CONCLUSION: Our study findings showed lower cardiac disorder risk with the NRT group compared to the non-NRT (varenicline and bupropion) group. While the study did not aim to undermine either using NRT or non-NRT for smoking cessation therapy to prevent smoking illness, the study results offer informed findings that could potentially improve current smoking cessation management using NRT intervention among smokers and enhance smokers' health outcome. Despite the negative signal detection of cardiac disorder risk with NRT as compared to non-NRT in final findings, we still recommend further research on the causal relationship between NRT and non-NRT and cardiac disorder risk.

Hospital survey on patient safety culture (HSOPSC): a multi-method approach for target-language instrument translation, adaptation, and validation to improve the equivalence of meaning for cross-cultural research.

BACKGROUND: The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument. METHODS: This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation. RESULTS: The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate). CONCLUSIONS: The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.

A Comparison of Practice Patterns Among Certified and Noncertified Asthma Educators.

BACKGROUND: Asthma educators are essential for providing patients with the knowledge and skills needed to control asthma. The purpose of this descriptive, cross-sectional survey was to examine the differences in practice patterns between certified and noncertified asthma educators. METHODS: Subjects (N = 98) included certified asthma educators (n = 66) and noncertified asthma educators (n = 32) who provided asthma education directly to patients and their families. Subjects were asked to complete an asthma task assessment tool, composed of a 31-item Likert scale survey based on the AE-C certification exam content and the National Asthma Education Prevention Program's Expert Panel Report 3 guidelines, which include 6 domains of asthma education (ie, the asthma condition, assessing the patient and family, behavioral and environmental factors, asthma management education, asthma medications, and organizational issues). Subjects identified frequency in performing specific asthma education tasks on a scale from "Always" to "Never." RESULTS: Noncertified asthma educators were significantly more likely than certified asthma educators to report performing tasks more frequently than certified asthma educators for item 17: Explain the definition of asthma control and loss of control, and controlled versus not well controlled. The largest difference in reported means between certified and noncertified asthma educators was for item 8: Diagnose asthma, with certified asthma educators reporting higher frequencies. Certified asthma educators reported higher frequency scores on 11 of the 31 tasks. CONCLUSIONS: For a majority of the education tasks, certified versus noncertified responses did not differ in their reported frequency of performing education tasks. Future researcher should examine the potential differences in patient outcomes based on provider certification status.

Examining factors affecting parental satisfaction with speech therapy in children with Phelan-McDermid Syndrome.

Objectives: This paper explores the relationship between speech therapy intensity and parent satisfaction with speech therapy (ST) in children with Phelan-McDermid Syndrome (P-MS), a rare genetic disorder. Methods: ST intensity (ST Dose [minutes per session]) × (ST Dose Frequency) × (ST Length [years]) and parent satisfaction (modified PSQ-18) with ST were measured by online questionnaire. Non-parametric correlation, partial correlation, and linear regression calculations were performed. Results: Significant correlations between ST Dose and parent satisfaction were observed in the subscales of Time Spent with ST (r = .36, p < .05) and Accessibility and Convenience (r = .40, p < .05) in children with P-MS controlling for child age. ST Dose was also a significant independent predictor of parent satisfaction with ST in specific subscales. Conclusion: Significant positive correlation and linear regression results indicate increases in ST Dose (minutes per session) represent a mechanism for increasing parent satisfaction with ST in children with P-MS.

Effects of Tactical Emergency Casualty Care Training for Law Enforcement Officers.

OBJECTIVE: This study evaluated how Tactical Emergency Casualty Care (TECC) training prepared law enforcement officers (LEOs) with the tools necessary to provide immediate, on-scene medical care to successfully stabilize victims of trauma. METHODS: This was a retrospective, de-identified study using a seven-item Fairfax County (Virginia USA) TECC After-Action Questionnaire and Arlington County (Virginia USA) police reports. RESULTS: Forty-six encounters were collected from 2015 through 2016. Eighty-four percent (n=39) of the encounters were from TECC After-Action Questionnaires and 15% (n=7) were from police reports. The main injuries included 13% (n=6) arterial bleeds, 46% (n=21) mild/moderate bleeds, 37% (n=17) large wounds, 20% (n=9) penetrating chest wounds, and 13% (n=6) open abdominal wounds. One-hundred percent of officers reported success in stabilizing victim injuries. Seventy-four percent of officers (n=26) did not encounter problems caring for a patient while 26% (n=9) encountered a problem. Ninety-seven percent (n=37/38) answered Yes, the training was sufficient, and three percent (n=1) indicated it was OK. CONCLUSION: This is the most comprehensive study of TECC use among LEOs to date that supports the importance of TECC training for all LEOs in prehospital trauma care. Results of this study showed TECC training prepared LEOs with the operational tools necessary to provide immediate, on-scene medical care to successfully stabilize victims of trauma. Continuing to train increasing numbers of LEOs in TECC is key to saving the lives of victims of trauma in the future. RothschildHR, MathiesonK. Effects of Tactical Emergency Casualty Care training for law enforcement officers. Prehosp Disaster Med. 2018;33(5):495-500.

Randomized trial of oral versus intravenous acetaminophen for postoperative pain control.

PURPOSE: Results of a study comparing pain control outcomes with preoperative oral versus intraoperative i.v. acetaminophen use in adults undergoing total hip or knee arthroplasty are reported. METHODS: A single-center, randomized, placebo-controlled, equivalence trial was conducted. Patients were assigned (1:1) to receive 2 500-mg capsules of acetaminophen before surgery, with an i.v. placebo infusion during surgery (the oral group), or 2 oral placebo capsules followed by an i.v. infusion of acetaminophen 1,000 mg/100 mL (the i.v. group). Patients were followed after postanesthesia care unit (PACU) admission up to 24 hours postoperatively. RESULTS: Among 486 patients included in a modified intention-to-treat analysis (mean ± S.D. age, 66.3 ± 9.4 years), there were no significant differences in preoperative and intraoperative use of pain medication between the oral and i.v. groups. Postoperative opioid use in morphine milligram equivalents (MMEs) was equivalent in the oral and i.v. groups (i.e., the mean difference in median MME values was within the prespecified equivalence margin), with no significant between-group differences in mean pain scores over 24 hours. CONCLUSION: In patients undergoing hip or knee arthroplasty, oral acetaminophen given preoperatively was equivalent to i.v. acetaminophen administered in the operating suite in controlling pain in the immediate postoperative period. I.V. acetaminophen was not superior to oral acetaminophen in reducing postoperative nausea and vomiting, time to ambulation, time to first dose of as-needed pain medication, length of PACU stay, or total length of hospital stay.

Access to Digital Communication Technology and Perceptions of Telemedicine for Patient Education among American Indian Patients with Diabetes.

INTRODUCTION: Health care access for medically underserved patients managing chronic conditions is challenging. While telemedicine can support patient education and engagement, the "digital divide" may be particularly problematic among the medically underserved. This study evaluated physical access to digital devices, use of e-mail and social media tools, and perceptions of telemedicine among American Indian (AI) patients with diabetes mellitus (DM). METHODS: Survey data were collected from AI patients with DM during teleophthalmology exams. RESULTS: Eighty-eight percent of patients had access to digital device(s), 70% used e-mail, and 56% used social media. Younger age and greater education were positively associated with e-mail and social media use (p < .05). Most (60%) considered telemedicine an excellent medium for health-related patient education. DISCUSSION: American Indian patients with DM had access enabling patient education via telemedicine. Future work should examine patient technology preferences and effectiveness of technology-based education in improving outcomes among medically underserved populations.

Attitudes of Physician Assistant Educators Toward Interprofessional Education and Collaborative Care.

PURPOSE: Interprofessional education (IPE) has been shown to improve collaboration in the workforce, ultimately improving patient care. The purpose of this study was to evaluate physician assistant (PA) educators' attitudes toward IPE and interprofessional (IP) health care teams. METHODS: An online survey was sent to 1198 PA educators. The survey assessed 3 domains: attitudes toward IPE, attitudes toward IP health care teams, and attitudes toward IP learning in the academic setting. RESULTS: Most participants were involved in some form of IPE. Faculty attitudes were positive in all 3 domains but were more favorable toward IPE. CONCLUSIONS: The positive attitudes held by PA faculty members may change the way in which curricula are conceived and delivered, influencing IP collaboration of future health care providers.

U.S. Dental Hygiene Students' Perceptions of Interprofessional Collaboration.

Patients with complex medical conditions require collaboration among multiple health care providers, and dental hygienists must be prepared to communicate effectively with medical providers to provide comprehensive quality patient care. The aim of this study was to assess U.S. dental hygiene students' attitudes about interprofessional collaboration (IPC) and identify any differences based on age, year in program, and program location. Participants were limited to students enrolled in dental hygiene associate degree programs across the United States. In response to an email soliciting participation sent to all dental hygiene program directors, 504 students completed the Interdisciplinary Education Perception Scale (IEPS) online (response rate could not be calculated). The IEPS is a validated survey that measures attitudes about interprofessional collaboration. The majority of the respondents were female (97%) and under 30 years of age (74.6%). Their mean scores indicated positive attitudes about IPC. There were no statistically significant differences in scores by age (p=0.700) or program location (p=0.527). There were also no statistically significant differences between first- and second-year students for total mean scores (p=0.106); for the competency and autonomy subscale (p=0.125); and for the perception of actual cooperation subscale (p=0.890). There was a statistically significant difference between first- and second-year students on the perception of actual cooperation subscale, with first-year students scoring higher than second-year students (p=0.016). This study's findings of positive attitudes about IPC and that age and program location had little bearing on the responses suggest that associate degree dental hygiene students may welcome the interprofessional education that will prepare them for practice in the future.

Radiation Safety among Workers in Health Services.

The purpose of this study was to survey health service workers regarding their radiation safety knowledge and practice. Participants were health service workers (n = 721) who received an anonymous online survey by email to test their radiation safety knowledge. A knowledge test of 15 questions was completed by 412 respondents. The overall average percent correct was 77.9%. Health physicists/medical physicists had the highest average percent score (93.5%), while physician assistants scored the lowest (60.0%). Of all the respondents, only 64.0% reported they participated in periodic radiation safety training at their place of employment. The most common topic selected where participants wanted additional training was in biological effects of radiation (41.0%). In conclusion, radiation safety training and education needs to be developed and planned effectively. Areas or specialties with poor radiation safety knowledge need to be addressed with corresponding safety measures.

The Effect of Blood Glucose Self-Monitoring Among Inmates With Diabetes.

The increasing prevalence and risk of complications from diabetes necessitate patient participation and attentiveness to select appropriate foods, perform regular physical activity, and be active in diabetes management and self-maintenance. Diabetes is often largely asymptomatic; consequently, early diagnosis and treatment are necessary. Inmates are a unique population challenged by the increased prevalence of chronic conditions including diabetes. Diabetes standards for inmates contain diagnostic and treatment management guidelines that incorporate personal glucose monitoring for insulin users. In December 2009, the Federal Bureau of Prisons initiated a program to distribute glucose meters to insulin-dependent inmates to facilitate self-monitoring blood glucose. The purpose of this study was to evaluate the effect of these glucose meters on hemoglobin A1c levels.

Differences in quality of life between pediatric sickle cell patients who used hydroxyurea and those who did not.

PURPOSE: The purpose of this paper is to examine the differences in quality of life (QoL) between two groups of pediatric sickle cell patients: those who used hydroxyurea and those who chose not to use the medication to treat sickle cell disease. DESIGN/METHODOLOGY/APPROACH: The study was a quantitative, non-randomized, cross-sectional, comparative study. In total, 100 children ages seven to 17 participated in the study. Parents of the patients completed a demographic questionnaire while the participants completed the Pediatric Quality of Life Inventory (Peds QoL) and Sickle Cell Disease Quality of Life Inventory (SCD QoL). FINDINGS: The Ped QoL regression analysis revealed that hydroxyurea use and parental marital status accounted for a significant proportion of the variance in Ped QoL. The SCD QoL regression analysis also revealed that hydroxyurea and age accounted for a significant proportion of the variance in SCD QoL. Finally, the regression analysis revealed that SCD, parental marital status, parental income, sex, age, race and number of siblings did not account for a significant proportion of the variance in SCD crises per year. ORIGINALITY/VALUE: This paper proved a need to study the differences in QoL between those pediatric patients who used hydroxyurea and those who did not use the medication.

Critical incidents, successes, and challenges of community-based dental education.

In 2006, the Arizona School of Dentistry & Oral Health at A.T. Still University (ATSU ASDOH) implemented an intensive community-based education program for its inaugural fourth-year students called the Integrated Community Service Partnerships (ICSP) program. As part of the ICSP program, students spend half of their clinical experience (approximately ninety-five days) in rotations at four or five community-based clinics. More than sixty clinics in Arizona and throughout the country serve as rotation sites. ATSU ASDOH conducts focus groups with all fourth-year students prior to graduation for program improvement and research. The purpose of this study was to characterize critical incidents students identified as instrumental to learning, as well as successes and challenges of the program. Qualitative data from the 2009 and 2010 focus groups were analyzed, including a total of 104 students. The types of critical incidents students chose to describe in the focus groups involved patient factors, contextual factors, and interpersonal factors. While students believed their ICSP program external rotation experiences were fundamental in their clinical and professional development, they also noted challenges associated with this intense community-based education program.

Perceived influence of community oral health curriculum on graduates' dental practice choice and volunteerism.

The purpose of this study was to determine if A.T. Still University Arizona School of Dentistry and Oral Health (ASDOH) curricular content regarding community oral health has influenced graduates' dental practice choice and volunteering activities in their communities. At ASDOH, the community oral health curriculum consists of three components: 1) coursework in public health resulting in a certificate or master's degree in public health; 2) service-learning activities in the Dentistry in the Community series of course modules, wherein students plan and implement community projects; and 3) community-based clinical rotations of approximately ninety-five days during the fourth year. To accomplish the purposes of the study, a survey was sent to ASDOH alumni who graduated between 2007 and 2010. Of the 208 graduates contacted, ninety-four responded (45.2 percent). Of those who responded, 85 percent reported that the community oral health curriculum influenced their practice choice, and 76 percent reported that they volunteer. Additionally, 58 percent of the respondents reported that the amount of dental school debt they had incurred affected their career plans and professional decision making.

A descriptive analysis of factors influencing physician assistant specialty selection.

This study assessed factors impacting practice selection among primary care and specialty physician assistants (PAs). Certified PAs randomized by the National Commission on Certification of Physician Assistants (NCCPA) (30,000) were surveyed, with 2,020 responses (RR = 6.7%). Results showed that factors influencing primary care and specialty selection differ. Increasing reimbursements may not increase selection of primary care by PAs.

Level of stress and common coping strategies among physician assistant students.

PURPOSE: This study assessed levels of stress and coping strategies in physician assistant (PA) students. METHODS: The study used a descriptive, cross-sectional design. Data were collected through an electronic survey that was sent to all current student members of the Texas Academy of Physician Assistants (N = 560). The Perceived Stress Scale was used to measure level of stress, and the Brief COPE Inventory was used to measure coping strategies. RESULTS: A total of 146 (26.3%) students participated in the study. Most respondents were female, young, single, and Caucasian/non-Hispanic. The mean stress score was 33.3, higher than that reported in the overall general US population. Areas of most concern included feeling nervous and stressed, feeling upset about unexpected happenings, and an inability to control life's irritations and manage personal problems. Self-distraction, venting, and self-blame were the most frequently used unhealthy coping strategies. Acceptance, active coping, and emotional support were the most frequently used positive coping strategies. CONCLUSION: The results of this study indicated that students in PA training experience higher levels of stress than the general population in the United States, making healthy coping strategies among PA students particularly important. The results of this study can inform future research, curriculum design, teaching methods, and educational intervention in PA training programs.