Comparison of GPS imputation methods in environmental health research.

Assessment of personal exposure in the external environment commonly relies on global positioning system (GPS) measurements. However, it has been challenging to determine exposures accurately due to missing data in GPS trajectories. In environmental health research using GPS, missing data are often discarded or are typically imputed based on the last known location or linear interpolation. Imputation is said to mitigate bias in exposure measures, but methods used are hardly evaluated against ground truth. Widely used imputation methods assume that a person is either stationary or constantly moving during the missing interval. Relaxing this assumption, we propose a method for imputing locations as a function of a person's likely movement state (stop, move) during the missing interval. We then evaluate the proposed method in terms of the accuracy of imputed location, movement state, and daily mobility measures such as the number of trips and time spent on places visited. Experiments based on real data collected by participants (n=59) show that the proposed approach outperforms existing methods. Imputation to the last known location can lead to large deviation from the actual location when gap distance is large. Linear interpolation is shown to result in large errors in mobility measures. Researchers should be aware that the different treatment of missing data can affect the spatiotemporal accuracy of GPS-based exposure assessments.

Relationships Between Physical Activity Metrics of Intensity and Diabetes.

INTRODUCTION: Physical activity (PA) prevents diabetes-associated complications. Little is known about what constitutes effective PA interventions to mitigate diabetes. Identifying PA metrics associated with the efficacy of PA interventions will provide insight into devising strategies to treat diabetes. PURPOSE: The aim of this study was to analyze the relationships between preclinical and postclinical variables from a 10-week intervention designed to increase PA in adults with diabetes. METHODS: A secondary analysis was performed to evaluate data using Wilcoxon rank sum test, permutation test and Spearman correlation to analyze hemoglobin A1c (HbA1c), weight, and PA metrics (maximum steps per episode, cadence, daily steps, and 6-minute walk). RESULTS: Poststudy HbA1c level was associated with maximum steps (r = -0.63, P = .03) and 6-minute walk (r = -0.50, P = .09). Baseline weight was associated with average cadence (r = -0.76, P = .007), and poststudy weight was associated with average cadence (r = -0.60, P = .041) and maximum steps (r = -0.62, P = .03). CONCLUSIONS: Cadence and maximum steps per episode reflect PA intensity and were associated with HbA1c and weight in adults with diabetes.

Global impact of physical inactivity and implications for public health nursing.

Physicalinactivity has been a public health problem worldwide for more than a decade. Of those who are physically active, a substantial percentage engage solely in low or very low physical activity (PA) levels. In the last 3 decades, the prevalence of PA in the United States has decreased with approximately 80% of adults not meeting the recommended guidelines for aerobic and muscle strengthening PA. The PA levels of youth have dramatically decreased with 85% of adolescents reporting no PA. Regular PA participation can aid in preventing chronic diseases. A strong inverse dose-response relationship exists between PA and the incidence of cardiovascular disease, all-cause and cardiovascular mortality. Moreover, low cardiorespiratory fitness levels are a risk factor for cardiovascular diseases: the leading cause of death and disability globally. Conversely, high amounts of moderate-to-vigorous intensity PA at levels 3-5 times recommended in guidelines reduce risk for all cause mortality. Socio-ecological determinants of PA are essential considerations for promoting across the life course. In health care and community settings, public health nurses have opportunities to promote PA through a socio-ecological approach across the life course of individuals and diverse populations.

Virtual pedagogical strategies and HESI student outcomes in response to COVID-19.

BACKGROUND: To maintain curricular integrity in response to COVID-19, nurse educators are increasingly required to transition from traditional (face-to-face) to virtual pedagogy. OBJECTIVES: The purpose of this analysis was to compare the HESI scores based on a traditional pedagogy with the HESI scores following implementation of virtual pedagogy during Spring 2020. METHODS: Student (n = 115; 81% female; mean age = 25.71 years) HESI scores were compared after each eight-week session using the Mann Whitney U test, permutation test and Wilcoxon rank test. Logistic regression was used to identify students achieving at least 850. Chi-square test was used to determine the relationship between pedagogy and students meeting 850 HESI scores. Fall 2019 Exit HESI scores were also compared with Spring 2020 Exit HESI scores. RESULTS: Students from diverse backgrounds (53.9% White; 27.8% Hispanic; 10.4% Asian; 5.2% Black; 1% Unknown) increased (p = 0.022) MHESI scores following virtual pedagogy in Fundamentals, although no difference was found in Maternity (p = 0.311), Psychiatric (p = 0.129) or Medical Surgical Nursing (p = 0.692). Wilcoxon rank test revealed significant differences in MHESI scores in same cohort of students between traditional (Psychiatric) and virtual strategies (Medical-Surgical) (p < 0.01); and traditional (Medical-Surgical) and virtual (Psychiatric) strategies (p = 0.023). White students' MHESI scores were higher than Asian students', as revealed by Logistic regression with no differences based on gender. Spring 2020 and Fall 2019 Exit HESI scores were comparable (p = 0.499). Chi-square analysis revealed no relationship between pedagogy and achieving at least 850 on HESI (χ2 = 0.027, p = 0.871). CONCLUSIONS: Based on the exit HESI scores, virtual pedagogy was as effective as traditional pedagogy for maintaining student competency in a community college associate degree nursing program. Future analyses of the effectiveness of virtual pedagogy in meeting curricular outcomes is warranted, regardless of exit degree option.

Improving Portfolio Assessment: Addressing Challenges in Transition to Eportfolio.

BACKGROUND: As health care education programs adopt electronic portfolios (eportfolios), a midwestern university baccalaureate nursing program faces challenges in transitioning from a 25-year-old paper-based system to eportfolio. METHOD: Process improvements and faculty development were implemented through collaboration with the information technology (IT) department and the involvement of students as ambassadors. Pre- and posttransition surveys and portfolio benchmarks were used to evaluate the efficacy of the new eportfolio system. RESULTS: Results of faculty and student surveys revealed improved positive experiences regarding the value, clarity, and ease of use of the eportfolio system. Benchmark deficits decreased from six of eight portfolio criteria in Fall 2017 to none in Fall 2019. CONCLUSION: Buy-in through faculty and student involvement, along with a user-centered design, are essential for a successful eportfolio transition. Student and faculty engagement would be secured when they are well-informed in the transition process. [J Nurs Educ. 2020;59(12):705-708.].

Feasibility of a Low-Intensity, Technology-Based Intervention for Increasing Physical Activity in Adults at Risk for a Diabetic Foot Ulcer: A Mixed-Methods Study.

BACKGROUND: Among adults with diabetes, 19-34% will develop a diabetic foot ulcer (DFU), which increases amputation risk and health care costs, and worsens quality of life. Regular physical activity, when increased gradually, may help prevent DFUs. In this mixed-methods study, we examined the feasibility of a low-intensity, technology-based behavioral intervention to increase activity in adults at risk for DFUs. METHOD: Participants at risk for a DFU (n = 12; 66% female; mean age = 59.9 years) received four in-person exercise and behavioral counseling sessions over 2-3 weeks, supplemented with use of an activity monitor (to track steps) and text messages (to reinforce behavioral strategies) for an added 8 weeks. Pre- and postintervention assessments of accelerometer measured activity, daily mobility, and glycemic control (A1C) were completed. Treatment acceptability was assessed by questionnaire and via key informant interview. RESULTS: The program appears feasible since all but one participant attended all four sessions, all used the activity monitor and all responded to text messages. Treatment acceptability (scale: 1 = very dissatisfied, 5 = extremely satisfied) was high; average item ratings were 4.79 (SD = 0.24). Participants increased their steps by an average of 881.89 steps/day (d = 0.66). A1C decreased on average by 0.33% (d = 0.23). Daily mobility did not change. Interview results suggest that participants perceived benefits from the intervention. Participant recommended improvements included providing more physical activity information, addressing pain, and intervention delivery in a podiatry clinic. CONCLUSION: Individuals at risk for a DFU might benefit from a minimally intensive, technology-based intervention to increase their physical activity. Future research comparing the intervention to usual care is warranted.

Prevention and Treatment of Pediatric Obesity: A Strategy Involving Children, Adolescents and the Family for Improved Body Composition.

PURPOSE: Pediatric obesity is a serious health problem affecting 1 of 6 children in the U.S. A two- to threefold increased incidence is evident in the last two decades. This study analyzes the outcomes of the ProActive Kids Foundation three-tiered early intervention program to determine the improvement in body composition in overweight and obese youth by incorporating the family along with the pediatric participant. METHODS: We analyzed data from 884 overweight (BMI between 85% and 95th percentile) or obese (BMI > 95th percentile) youth (5 to 17 years) in a major metropolitan area in Illinois, to determine body composition improvement from an 8-week intervention between 2010 and 2017. Weight, percent body fat, fat free mass and BMI were analyzed using mixed model analysis, ANCOVA and paired t-test analysis. RESULTS: All measures of weight, percent body fat, fat free mass and BMI improved significantly in pediatric participants. Age, county of residence and time impacted weight, body fat, fat free mass and BMI. Gender did not impact the average change in weight or BMI. CONCLUSIONS: The ProActive Kids early intervention program utilizes a targeted approach for the treatment of pediatric obesity during critical developmental ages. By educating parents along with children and adolescents about mental health coaching (lifestyle), nutrition and physical activity, we observed improvements in body composition that have potential to be sustainable. PRACTICE IMPLICATIONS: The ProActive Kids strategy provides a successful model for future treatment and prevention of pediatric obesity.

Relationships Between Glycemic Control and Cardiovascular Fitness.

INTRODUCTION: Diabetes is a serious health problem affecting approximately 29.1 million individuals in the United States. Another 86 million have prediabetes. The development and implementation of lifestyle modifications such as physical activity for these persons are among the most effective methods for prevention and treatment. OBJECTIVE: The aim of this study was to examine relationships between glycemic control (HbA1c) and cardiovascular fitness (peak maximal oxygen uptake [VO2 peak] and ventilatory threshold [VT]) in overweight/obese subjects with and without type 2 diabetes (T2DM). In addition, the influences of body mass index (BMI) and insulin sensitivity (homeostasis model assessment [HOMA %S]) on the relationship between glycemic control and cardiovascular fitness were explored. METHOD: Data were abstracted from a completed study that included 51 overweight or obese subjects with T2DM ( n = 18), impaired glucose tolerance ( n = 8), or normal glucose tolerance ( n = 25). Relationships between glycemic control (HbA1c) and cardiovascular fitness (VO2 peak and VT) were determined using correlational analysis and multiple linear regression analyses. RESULTS: A statistically significant relationship was observed between HbA1c and cardiovascular fitness. However, BMI and HOMA %S did not influence the relationship between glycemic control and cardiovascular fitness. DISCUSSION: HbA1c contributes to VO2 peak and VT in obese and overweight subjects across glucose tolerance categories. Significant results were achieved despite the fact that there was a limited range of HbA1c based on the study inclusion criteria. This finding suggests that even a mild decrease in glycemic control can negatively influence cardiovascular fitness.