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Exposure to community adversities and violence can be associated with a cascade of neurocognitive, mental health, and behavioral challenges among urban adolescents. Influenced by the bio-ecological framework, this study examines if problems with executive functioning (EF) exacerbate the relation between exposure to community adversity and violence and internalizing symptoms (e.g., depression, anxiety, and somatic symptoms) and externalizing behaviors (e.g., hyperactivity and attention problems) for males and females. Participants included 300 primarily African American and Latine adolescents (M[subscript age] = 15.42, SD = 1.21; 51% female) who reside in 30 census tracts from urban neighborhoods historically and systematically divested from, located on the West and South sides of Chicago. Pending the radical reconfiguration of power, systems, and community to fundamentally challenge the systemic policies and processes that contribute to these adverse experiences, findings from this study provide important implications for clinical practice and school-based interventions that could support adolescents' psychological, behavioral, and emotional needs.

Background: Young Arab American women are at risk for cardiovascular disease, but there is limited data on their physical activity (PA) engagement. Objectives: The aim of this study was to examine the relationship between PA and its correlates in young Arab American women. The objectives of this study were to: (1) describe self-reported lifestyle PA behaviors of young Arab American women and (2) examine the relationship between their self-reported lifestyle PA, device-measured lifestyle PA (combined moderate / vigorous and steps), and potentially associated factors (demographics, physical measures, individual factors, and behavior cognition factors). Methods: This cross-sectional study was conducted with women 18 to 35 years of age and Arab American (n = 50) in the Midwest Region of the United States. Participants wore ActiGraph GT3X-BT monitors for 7 days; self-report measures included the International Physical Activity Questionnaire, demographics, acculturation, discrimination, religiosity, self-efficacy, and social support. Results: The mean age of participants was 25.5 years (SD : 5.5; range: 18-35). Per ActiGraph, the average daily steps were 5946 (SD : 2783); only 24% met the moderate-intensity PA guidelines. Self-efficacy was significantly associated with increased moderate-to-vigorous PA (B = 0.37; P =.012). Conclusion: The average daily steps for the young Arab American women in this study were of low active classification. More than 75% of the women failed to meet the recommended weekly moderate / vigorous PA guidelines. Our study supports the importance of targeting and tailoring PA interventions on young Arab American women who have low self-efficacy for overcoming barriers to lifestyle PA. [ABSTRACT FROM AUTHOR]

Co-occurring social-emotional problems are associated with increased risk of aggression and substance use. However, few studies examine their configurational patterns. This study identifies patterns of co-occurring social skills, anxiety, learning, and conduct problems among 2,632 urban boys at entry into sixth grade, and their related aggression and substance use trajectories through eighth grade. Latent class analysis revealed four patterns at school entry: "low-all," "poor social skills," "positive social skills," and "high all." Findings point to important variation in risk. Problem behaviors increased the least through middle school for the "low-all" pattern. The "positive social skills" pattern had an average increase, while the "poor social skills" pattern had higher levels of problem behaviors in sixth and seventh grade. The "high all" showed the fastest increase in problem behaviors and the highest levels in eighth grade. Discussion focuses on implications for a multi-tiered school-based system of supports for behavioral risk management.

Although obesogenic behaviors (physical activity and/or sedentary behavior and dietary intake) are known predictors of childhood weight status, little is known about mother and child behaviors contributing to obesogenic behaviors and obesity in Hispanic preschool children, whose obesity rate is higher than in non-Hispanic Whites and non-Hispanic Blacks. The purpose of this cross-sectional, descriptive study was to examine relationships among child temperament, maternal behaviors (feeding practices and parenting style), child obesogenic behaviors, and child weight status in 100 Hispanic preschool children. Results showed that higher scores on the negative affectivity dimension of child temperament were associated with higher scores on the dimension of permissive parenting, and permissive parenting was associated with less time spent in sedentary behaviors (B = -3.53, confidence interval [-7.52, -0.90]). Findings can guide school nurses in developing interventions that consider child temperament and parenting style to promote nonobesogenic behavior in Hispanic preschoolers.

Background Admission and discharge screening of patients for asymptomatic gut colonization with multidrug-resistant organisms (MDROs) is a common approach to active surveillance, but its sensitivity for detecting colonization is uncertain. Methods Daily rectal or fecal swab samples and associated clinical data were collected over 12 months from patients in one 25-bed medical intensive care unit (ICU) in Chicago, IL and tested for the following MDROs: vancomycin-resistant enterococci; third-generation cephalosporin-resistant Enterobacterales, including extended-spectrum β-lactamase-producing Enterobacterales; and carbapenem-resistant Enterobacterales. MDRO detection by (1) admission and discharge surveillance cultures or (2) clinical cultures were compared to daily surveillance cultures. Samples underwent 16S rRNA gene sequencing to measure the relative abundance of operational taxonomic units (OTUs) corresponding to each MDRO. Results Compared with daily surveillance cultures, admission/discharge cultures detected 91% of prevalent MDRO colonization and 63% of MDRO acquisitions among medical ICU patients. Few (7%) MDRO carriers were identified by clinical cultures alone. Higher relative abundance of MDRO-associated OTUs and specific antibiotic exposures were independently associated with higher probability of MDRO detection by culture. Conclusions Admission and discharge surveillance cultures underestimated MDRO acquisitions in an ICU. These limitations should be considered when designing sampling strategies for epidemiologic studies that use culture-based surveillance. [ABSTRACT FROM AUTHOR]

Background: Vascular diseases, including atherosclerotic cardiovascular disease (ASCVD) and stroke, increase the risk of Alzheimer's disease and cognitive impairment. Serum biomarkers, such as brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor 1 (IGF-1), may be indicators of cognitive health. Objective: We examined whether vascular risk was associated with levels of cognition and serum biomarkers in older women with cardiovascular disease (CVD). Methods: Baseline data from a lifestyle trial in older women (n = 253) with CVD (NCT04556305) were analyzed. Vascular risk scores were calculated for ASCVD (ASCVD risk estimator) and stroke (CHA2DS2-VASc) based on published criteria. Cognition-related serum biomarkers included BDNF, VEGF, and IGF-1. Cognition was based on a battery of neuropsychological tests that assessed episodic memory, semantic memory, working memory, and executive function. A series of separate linear regression models were used to evaluate associations of vascular risk scores with outcomes of cognition and serum biomarkers. All models were adjusted for age, education level, and racial and ethnic background. Results: In separate linear regression models, both ASCVD and CHA2DS2-VASc scores were inversely associated with semantic memory (β= –0.22, p = 0.007 and β= –0.15, p = 0.022, respectively), with no significant findings for the other cognitive domains. There were no significant associations between vascular risk scores and serum biomarkers. Conclusions: Future studies should prospectively examine associations between vascular risk and cognition in other populations and additionally consider other serum biomarkers that may be related to vascular risk and cognition. [ABSTRACT FROM AUTHOR]

Background Environmental contamination is suspected to play an important role in Candida auris transmission. Understanding speed and risks of contamination after room disinfection could inform environmental cleaning recommendations. Methods We conducted a prospective multicenter study of environmental contamination associated with C. auris colonization at 6 ventilator-capable skilled nursing facilities and 1 acute care hospital in Illinois and California. Known C. auris carriers were sampled at 5 body sites followed by sampling of nearby room surfaces before disinfection and at 0, 4, 8, and 12 hours after disinfection. Samples were cultured for C. auris and bacterial multidrug-resistant organisms (MDROs). Odds of surface contamination after disinfection were analyzed using multilevel generalized estimating equations. Results Among 41 known C. auris carriers, colonization was detected most frequently on palms/fingertips (76%) and nares (71%). C. auris contamination was detected on 32.2% (66/205) of room surfaces before disinfection and 20.5% (39/190) of room surfaces by 4 hours after disinfection. A higher number of C. auris –colonized body sites was associated with higher odds of environmental contamination at every time point following disinfection, adjusting for facility of residence. In the rooms of 38 (93%) C. auris carriers co-colonized with a bacterial MDRO, 2%–24% of surfaces were additionally contaminated with the same MDRO by 4 hours after disinfection. Conclusions C. auris can contaminate the healthcare environment rapidly after disinfection, highlighting the challenges associated with environmental disinfection. Future research should investigate long-acting disinfectants, antimicrobial surfaces, and more effective patient skin antisepsis to reduce the environmental reservoir of C. auris and bacterial MDROs in healthcare settings. [ABSTRACT FROM AUTHOR]

High engagement in lifestyle health behaviors appears to be protective against cognitive decline in aging. We investigated the association between patterns of modifiable lifestyle health behaviors and common brain neuropathologies of dementia as a possible mechanism. We examined 555 decedents from the Rush Memory and Aging Project, free of dementia at their initial concurrent report of lifestyle health behaviors of interest (physical, social, and cognitive activities, and healthy diet), and who underwent a postmortem neuropathology evaluation. First, we used latent profile analysis to group participants based on baseline behavior patterns. Second, we assessed the associations of profile membership with each neurodegenerative (global Alzheimer's disease [AD] pathology, amyloid-beta load, density of neurofibrillary tangles, and presence of cortical Lewy bodies and TAR DNA-binding protein 43 cytoplasmic inclusions) and neurovascular pathologies (presence of chronic gross or microscopic infarcts, arteriolosclerosis, atherosclerosis, and cerebral amyloid angiopathy), using separate linear or logistic regression models, adjusted for age at death, sex (core model), vascular disease risk factors, and vascular conditions (fully adjusted model). Participants had either consistently lower (N  = 224) or consistently higher (N  = 331) engagement across 4 lifestyle health behaviors. We generally found no differences in neuropathologies between higher and lower engagement groups in core or fully adjusted models; for example, higher engagement in lifestyle health behaviors was not associated with global AD pathology after core or full adjustment (both p  > .8). In conclusion, we found no evidence of associations between patterns of lifestyle health behaviors and neuropathology. Other mechanisms may underlie protective effects of health behaviors against dementia. [ABSTRACT FROM AUTHOR]

Introduction: The use of mobile delivery to deliver parent training can address barriers to access and improve the translation of interventions in existing settings like pediatric primary care. Studying implementation provides critical information to identify and address barriers and facilitators and inform sustainability efforts. Method: This study was a descriptive evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework as part of a Hybrid Type I Effectiveness-Implementation trial of the ezParent Program within 4 pediatric primary care clinics. We collected data before, during, and after implementation to evaluate provider implementation and their perspectives on program benefits and barriers to implementation. Results: On average, 14% of eligible parents were introduced to the study. Of these parents, 78% expressed interest in participating and 37% enrolled in the study. Seventy-eight percent of staff providers (n = 36) implemented the procedures at least once, and among those who implemented 3 or more times (n = 24), 79% maintained implementation for 6 months. Barriers to implementation include limited time, lack of information, and full practice buy-in and engagement. Discussion: Implementation fidelity may improve with additional education and training of the interdisciplinary team, clear messaging regarding the purpose and content of the ezParent program, defining roles within the care team, identifying practice champions, and use of the electronic health record. Findings from this evaluation, including data from the randomized controlled trial and literature to support intervention effectiveness and implementation, will be used to develop an implementation toolkit to include specific strategies for implementation and ideas for local adaptations. Keywords: parent training, implementation, mHealth, digital delivery, pediatric primary care, Parent training (PT) is the gold standard for helping parents develop skills to effectively manage problem behaviors, promote positive behaviors, and prevent maltreatment (Chen & Chan, 2016; SAMHSA's National Registry [...]

INTRODUCTION: We aimed to identify profiles of modifiable, late‐life lifestyle health behaviors related to subsequent maintenance of cognition and explore sociodemographics and health characteristics as effect modifiers. METHODS: Analyses used data from 715 older adults without baseline dementia from the Rush Memory and Aging Project and with lifestyle health behaviors (physical activity, cognitive activity, healthy diet, social activity) at baseline and ≥ 2 annual assessments of cognition. We used latent profile analysis to group participants based on behavior patterns and assessed change in cognition by group. RESULTS: Three latent profiles were identified: high (n = 183), moderate (n = 441), and low (n = 91) engagement in health behaviors. Compared to high engagement, the moderate (mean difference [MD] = ‐0.02, 95% CI = [‐0.03;‐0.0002], p = 0.048) and low (MD = ‐0.06, 95% CI = [‐0.08;‐0.03], p < 0.0001) groups had faster annual rates of decline in global cognition, with no significant effects modifiers (vascular risk factors, apolipoprotein E [APOE] ε4, motor function). DISCUSSION: Avoiding low levels of lifestyle health behaviors may help maintain cognition. Highlights: Latent profile analysis (LPA) captures lifestyle health behaviors associated with cognitive function.Such behavior include physical activity, cognitive activity, healthy diet, social activity.We used LPA to examine associations of behaviors and cognitive function over time.Older adults with low lifestyle health behaviors showed more rapid decline.To a lesser degree, so did those with moderate lifestyle health behaviors.Vascular conditions and risks, APOEε4, or motor function did not modify the effect. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the associations between social determinants of health, health behaviors, and physical and mental health among African American and Hispanic caregiving grandmothers. We use cross-sectional secondary data from the Chicago Community Adult Health Study, originally designed to understand the health of individual households based on residential context. In a multivariate regression model, discrimination, parental stress, and physical health problems were significantly associated with depressive symptoms in caregiving grandmothers. Considering the multiple sources of stress experienced by this grandmother sample, researchers should develop and strengthen contextually relevant interventions for improving the health of caregiving grandmothers. Healthcare providers must be equipped with skills to address caregiving grandmothers' unique needs related to stress. Finally, policy makers should promote the development of legislation that can positively influence caregiving grandmothers and their families. Expanding the lens through which caregiving grandmothers living in minoritized communities are viewed can catalyze meaningful change. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment disproportionately affects older women with cardiovascular disease (CVD). Physical activity (PA) and cognitive training (CT) may have synergistic effects in combined interventions. However, no combined intervention has targeted women with CVD or utilized a sustainable and preferable lifestyle approach. The purpose was to test feasibility and acceptability of the 24-week MindMoves program, a lifestyle intervention that combined PA and CT developed for older women with CVD. Methods: The PA component included goal setting with Fitbits and 5 behavioral group meetings. The CT component was evidence-based BrainHQ delivered on a tablet in three 30-minute weekly sessions. Participants included 10 women aged =65 years with CVD. Exclusion criteria were cognitive impairment, regular PA, and CT use. Measures were feasibility (recruitment, attendance, participation, retention, and acceptability), change in PA (Fitbit min/steps), and change in cognitive function (NIH Toolbox®). Results: Of the 10 participants, 70% attended =4/5 group meetings, and overall attendance was 76%. Participants completed 2.3/3 CT sessions weekly. Participant retention was 100%. Over 90% of participants rated MindMoves with the highest levels of satisfaction. Participants had significant improvements in steps, light PA, and moderate PA, and there was a trend for improved cognition. Conclusions: Findings support testing MindMoves in an efficacy trial. [ABSTRACT FROM AUTHOR]

Background Inappropriate Clostridioides difficile testing is common in the hospital setting, leading to potential overdiagnosis of infection when single-step nucleic acid amplification testing is used. The potential role of infectious diseases (ID) specialists in enforcing appropriate C. difficile testing is unclear. Methods At a single 697-bed academic hospital, we performed a retrospective study from 1 March 2012 to 31 December 2019 comparing hospital-onset C. difficile infection (HO-CDI) rates during 3 consecutive time periods: baseline 1 (37 months, no decision support), baseline 2 (32 months, computer decision support), and intervention period (25 months, mandatory ID specialist approval for all C. difficile testing on hospital day 4 or later). We used a discontinuous growth model to assess the impact of the intervention on HO-CDI rates. Results During the study period, we evaluated C. difficile infections across 331 180 admission and 1 172 015 patient-days. During the intervention period, a median of 1 HO-CDI test approval request per day (range, 0–6 alerts/day) was observed; adherence by providers with obtaining approval was 85%. The HO-CDI rate was 10.2, 10.4, and 4.3 events per 10 000 patient-days for each consecutive time period, respectively. In adjusted analysis, the HO-CDI rate did not differ significantly between the 2 baseline periods (P =.14) but did differ between the baseline 2 period and intervention period (P <.001). Conclusions An ID-led C. difficile testing approval process was feasible and was associated with a >50% decrease in HO-CDI rates, due to enforcement of appropriate testing. [ABSTRACT FROM AUTHOR]

Data from 1,087 adolescent participants in three waves of the National Longitudinal Study of Adolescent Health were used to examine the effects of peer selection and socialization processes in adolescence on later reports of sexually transmitted infections (STI) and unintended pregnancies. Friends' attitudes and behavior were assessed with friends' reports. Among male adolescents, there was evidence for selection effects on STI diagnoses and socialization effects on reports of unintended pregnancy, both involving friends' attitudes. Among female adolescents, there was evidence for long-term effects of both socialization and selection processes involving same-sex friends' attitudes. Discussion focuses on the importance of peer and individual attitudes as potential intervention targets. (Contains 3 figures and 3 tables.)

This study sought to understand school-level influences on aggressive behavior and related social cognitive variables. Participants were 5106 middle school students participating in a violence prevention project. Predictors were school-level norms opposing aggression and favoring nonviolence, interpersonal climate (positive student-teacher relationships and positive student-student relationships), and school responsiveness to violence (awareness and reporting of violence and school safety problems). Outcomes were individual-level physical aggression, beliefs supporting aggression, and self-efficacy for nonviolent responses. School norms and both interpersonal climate variables had effects on all three outcomes in theorized directions. Only one of the responsiveness measures, awareness and reporting of violence, had theoretically consistent effects on all outcomes. The other, school safety problems, affected self-efficacy later in middle school. Evidence of gender moderation was generally consistent with greater influence of school-level factors on female adolescents. Discussion focuses on implications in light of previous research and intervention possibilities. (Contains 4 tables and 1 figure.)

This study examined the direct effects of beliefs about aggression and nonviolence on physical aggression and their role as protective factors that buffer adolescents from key risk factors in the peer, school, and parenting domains. Multilevel analyses were conducted on data from 5,581 adolescents representing two cohorts from 37 schools in four communities collected at the beginning and end of the sixth grade and at the end of the following 2 school years. Individual norms for aggression at Wave 1 moderated relations of delinquent peer associations and parental support for fighting with physical aggression. Self-efficacy for nonviolence at Wave 1 moderated relations of school risk, delinquent peer associations and parental support for fighting with physical aggression. There was clearer evidence for protective effects for self-efficacy for nonviolence for girls than for boys. (Contains 4 tables and 2 figures.)

The present brief report followed children exposed to consequences for violating Purchase, Use, and Possession (PUP) laws over time to assess changes in their smoking status. Youth in 24 towns were surveyed once a year for 3 years, and rates of tobacco use for those fined for PUP law violations were assessed. Of those who were given a ticket for a PUP law violation, 35 (39%) reported not smoking during year 1. Students in grade 7 were more likely to have quit smoking (84%) than those in grade 8 (35%), grade 9 (32%), or grade 10 (21%). For the two follow-up years, 45% and 41% reported not smoking. Assuming those who attrited were smokers, it is possible that about 15% to 24% of the original sample of children cited actually quit smoking over the follow-up period. The implications of these findings are discussed.