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The purpose of this study is to identify and compare the unmet needs of adolescents and young adults (AYAs) with cancer by age and gender. This is a mixed-methods study to analyze textual data from blog posts on AYAs' unmet needs. Themes were identified using a qualitative descriptive method with content analysis, and a quantitative method was used to compare themes by age and gender. The findings from blog posts of 100 AYAs showed that AYAs with cancer expressed somewhat different needs by age and gender. Young adults (26–39 years) with cancer tended to describe significantly more feelings of fear (p =.043) and parenting needs (p <.001) and significantly fewer educational needs (p <.001) than did emerging adults (18–25 years) with cancer. Female AYAs with cancer described significantly more feelings of guilt (p =.020), sexual needs (p =.003), fertility issues (p =.023), and social needs (p =.013) than did male AYAs with cancer. There were no statistically significant differences in the remaining themes between age and gender groups, although how they described unmet needs differed qualitatively. AYAs with cancer have various unmet needs and their unmet needs were different by age and gender. Nurses should proactively provide integrated systematic screening by offering a safe, non-judgmental environment to encourage AYAs to express their needs across their cancer journey. Nurses also should respond with developmentally appropriate support, resources, and referrals based on these expressed needs. • AYAs with cancer may express different needs by age and gender. • Young adults may have more feeling of fear and parenting needs than emerging adults. • Female AYAs may have more emotional, sexual, and social needs than male AYAs. • Integrated systematic screening for AYAs across their cancer journey is needed. [ABSTRACT FROM AUTHOR]

Although research about pregnancy for women with disabilities has increased, their postpartum experience has received little attention. Studies generally focus on parenting, not on the health of the mothers themselves, despite recent studies underscoring the health risks they may face. Thus, our purpose was to examine postpartum health among women with physical disabilities, including how they maintain or improve their health. Semistructured interviews were conducted with eleven new mothers with physically disabling conditions. A qualitative descriptive approach was used to analyze the transcribed interviews and identify themes. Nine women had delivered via cesarean section, and most had mobility impairments. Their average age was 35 years; 91% were college educated and 82% had a partner. Six overarching themes were identified: paying a price to have the baby, focus on the baby, supports—or a lack thereof, feelings of isolation, getting challenges under control/overcoming barriers, and not quite there yet/getting back to health promotion. Despite their resilience in dealing with the challenges of caring for their babies within the context of their disabling conditions (including recovery from complications from the birth experience), these women clearly identified the need for additional resources and supports. They also recognized limitations to their own health that came along with their parenting responsibilities. Health care providers should be more attuned to the postpartum needs of women with physical disabilities, and policies should provide additional supports such as insurance coverage for home visits to help maximize women's health and well-being during this important life transition. [ABSTRACT FROM AUTHOR]

Purpose To evaluate health literacy in a cohort of 75 adolescents with sickle cell disease (SCD). Design and Methods This cross-sectional, descriptive correlational study included assessment of demographic measures and appraisal of data resulting from completion of the REALM-Teen and Newest Vital Sign (NVS) instruments by 75 Black, non-Hispanic adolescents with SCD. Convenience sampling was utilized. Inclusion criteria were a diagnosis of one of the four primary genotypes of SCD and age 10–19 years. Results Thirty-seven males and 38 females were recruited for the study. Their mean age was 14.7 years (SD = 2.2; range 8.1). Their grade level ranged from 4 to 12 (mean 8.7; SD = 2.2). Scores on the REALM-Teen ranged from 12 to 66 (mean 53.7; SD = 12.8). Scores on the NVS ranged from 0 to 6 (mean 2.37; SD = 1.33). These health literacy scores were lower using both the REALM-Teen and the NVS instruments when compared to scores in all healthy adolescents and adults. Current grade level and health literacy scores showed a moderately high positive correlation ( r = 0.52, p < 0.01). Health literacy scores were also significantly positively correlated with age ( r = 0.49, p < 0.01) and income ( r = 0.37, p < 0.01). Conclusions Health literacy in adolescents with SCD is suboptimal. Future research should include identifying facilitators and barriers to health literacy levels in a larger cohort of adolescents with SCD. Practice Implications Health literacy is a potential facilitator of successful health outcomes for all adolescents. This study lays a solid foundation for future adolescent health literacy initiatives. [ABSTRACT FROM AUTHOR]

To interview individuals with long-standing Multiple Sclerosis about their perceptions of COVID-19 restrictions on health, health care access, and health promotion. A descriptive qualitative approach with maximum variation sampling was used to facilitate low inference interpretation. After coming to consensus on the codes, the researchers clustered the codes and used them to identify emerging themes, consistent with analytic techniques suggested by Miles and Huberman. Telephone interviews were conducted with individuals with multiple sclerosis living in the community who were recruited from the mailing list of the National MS Society. The 24 individuals interviewed had an average age of 66 years, and had been diagnosed an average of 32 years. Half were married, and 75% were female. Many had college degrees; six were employed. This is a qualitative study with no intervention. Self-reported health, health care access, and health promoting behaviors. Four interconnected themes emerged from the analysis: negative effects on health and health promotion, being isolated, loss of spontaneity in daily life, and resilience. Although most individuals initially reported no effect of COVID-19 on their health, additional probing revealed that some felt weaker and had more balance problems. Normal exercise regimens had been disrupted for approximately half of them. Several also described decreased social interactions; 80% expressed negative emotional impacts. Many utilized previously developed coping mechanisms, such as cognitive reframing, and support from family as they adapted to COVID-19. Most individuals reported no MS exacerbations and were able to have some contact with providers, usually through telehealth. Providers and researchers should monitor the on-going impact of the COVID-19 pandemic on physical functioning and emotional well-being among individuals with MS. Higher levels of depression have been previously reported among those with MS. For those needing mental health supports, rapid advancements in telehealth enable providers to refer them to psychological services provided through access from their homes. The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Cancer survivors 65 years of age and older experience treatment-induced memory impairments. However, clinicians do not intervene for these cognitive problems. This article describes the findings from a pilot study of a memory versus health training intervention and its adaptability for cancer survivors for symptom management. Design and Methods: A convenience sample of older adults was enrolled in a longitudinal study of a memory and health training intervention and tested on five occasions for 2 years postintervention. The memory training was designed to increase cognitive performance, reduce anxiety, decrease negative attributions, promote health, and increase memory self-efficacy. In this analysis, we included change over time for the first four of the five data collection points. We calculated means and standard deviations on the memory measures for cancer survivors in the intervention (n = 8) and comparison (n = 14) groups. The analysis consisted of a mixed design analysis of variance comparing the two intervention groups across four periods for 12 months. Results: The typical cancer survivor in the sample was a 74-year-old Caucasian female; 14% were minorities. Because of the small sample, some of the effects were not statistically significant. Moderate to large effects were revealed in everyday and verbal memory performance scores, memory self-efficacy, strategy use, and memory complaints. There were also moderate effects for group-by-time interactions on the visual memory performance measure, the memory self-efficacy measure, the depression, the trait anxiety measure, and the complaints subscale. The memory intervention group tended to improve more than the health training group, although this was not always consistent. The results suggested that the participants benefited from the memory training intervention. Implications: Clinicians are often at a loss on how to intervene with cancer survivors who are experiencing cognitive problems following chemotherapy treatment. Evidenced-based interventions for this aspect of symptom management are almost nonexistent. The Cognitive Behavioral Model of Everyday Memory (CBMEM), derived from Self-Efficacy theory provides an evidence-based intervention for symptom management. [Copyright &y& Elsevier]

We tested whether at-risk older adults receiving memory training showed better memory self-efficacy, metamemory, memory performance, and function in instrumental activities of daily living than participants receiving a health promotion training comparison condition. We followed participants for 26 months. The sample was mostly female (79%) and Caucasian (71%), with 17% Hispanics and 12% African Americans; average age was 75 years, and average education was 13 years. The memory training group made greater gains on global cognition and had fewer memory complaints, but both groups generally maintained their performance on the other cognitive measures and instrumental activities of daily living (IADLs) throughout the 24-month study period. Black and Hispanic participants made greater gains than Whites did on some memory performance measures but not on memory self-efficacy. The unexpected finding that minority elders made the largest gains merits further study. This study contributed to the knowledge base of geropsychiatric nursing by providing evidence for an effective psychosocial intervention that could be delivered by advanced practice nurses. [Copyright &y& Elsevier]

This article describes the outcomes of a psychosocial intervention that tested whether health training could improve health and functional ability in a group of community-residing elderly persons. The health-training intervention consisted of eight 90-minute lecture and discussion classes conducted twice a week for 1 month. In 3 months following the posttest, an additional four booster sessions were delivered once per week for 1 month. Participants received a total of 20 hours of health training. The National Institutes of Health-funded SeniorWISE (Wisdom is Simply Exploration) study was advertised in the community as a program to learn strategies for successful aging. We describe the health curriculum and the health and functional outcomes for a 6-month period at preintervention, postintervention, and postbooster sessions. Complete data were available for 110 individuals. There was a statistically significant change on the Direct Assessment of Functional Status, F(2, 107) = 4.69, P < .012. Health variables remained stable over time. This intervention demonstrated that health training has the potential for noticeable improvement in Instrumental Activities of Daily Living function. [Copyright &y& Elsevier]

Objective: Cancer-related cognitive impairment is common following the end of adjuvant treatment and there are limited treatment options for it. We compared the sustained cognitive (primary) and psychological (secondary) effects of mantra meditation to classical music listening 8 weeks after interventions ended (Time 3) compared to baseline (Time 1).Methods: A two-group parallel random assignment experimental design was used in a community setting. Thirty one breast cancer survivors (ages 21 to 75, received chemotherapy, and reported cognitive complaints) were randomly assigned to practice mantra meditation (n = 16) or listen to classical music (n = 15) 12 min a day for 8 weeks. No blinding was used. Repeated measures analysis of variance models were used to compare Time 1 and Time 3 data for the 26 survivors (13 per group) who completed the interventions and Time 3 data collection.Results: Verbal fluency (p < .001, ηp2 = 0.58), attention (p = .002, ηp2 = 0.33), immediate memory recall (p < .001, ηp2 = 0.38), perceived cognitive impairment (p < .001, ηp2 = 0.39), and quality of life (p = .001, ηp2 = 0.35) improved significantly across time for both groups. The two conditions did not differ significantly in changes across time. There were no adverse effects.Conclusion: Daily mantra meditation or classical music listening may be beneficial for cognitive outcomes and quality of life of breast cancer survivors with cancer-related cognitive impairment. The cognitive benefits appear to be sustained beyond the initial intervention period. Clinical Trials Registration number: NCT03696056, recruitment status completed. The study details can be accessed at: https://clinicaltrials.gov/ct2/show/NCT03696056 KEY MESSAGE: There are limited treatment options for managing cancer-related cognitive impairments. Daily mantra meditation or classical music listening for 12 min a day may improve cognitive outcomes and quality of life for cancer survivors, with no negative side effects. [ABSTRACT FROM AUTHOR]

Evidence that reduced treatment achieves similar outcomes is beneficial because shorter interventions may be more cost-effective and more acceptable to participants. We examined the effects of shortening a memory intervention for elders from eight sessions to four sessions. Shortening the intervention had little impact on either self-reported or performance measures of memory and daily living activities. Small to moderate effects were associated with positive changes in both groups. When examining cost-effectiveness, an eight-session intervention produced slightly greater gains in memory performance, but at a higher cost. Future studies should systematically vary key intervention components in more diverse samples. [Copyright &y& Elsevier]

Abstract: Stuifbergen AK, Blozis SA, Harrison TC, Becker HA. Exercise, functional limitations, and quality of life: a longitudinal study of persons with multiple sclerosis. Objective: To explore the trajectories of functional limitations, health behaviors (exercise), and quality of life (QOL) and their interrelations over a 5-year time period in a sample of persons with multiple sclerosis (MS). Design: Descriptive longitudinal survey study. Setting: Southwestern United States. Participants: Convenience sample of 611 people with MS (mean age at time 1, 49.4y). Ninety percent of the participants remained enrolled in the study. Response rates at each annual data collection ranged from 85% to 90% of eligible participants. Interventions: Not applicable. Main Outcome Measures: A series of self-report instruments to measure functional limitations, exercise behaviors, and QOL were completed annually over a 5-year period. Results: Using multivariate latent curve modeling techniques, rates of change in functional limitations correlated negatively with rates of exercise behaviors and QOL ratings. The level of exercise behaviors at time 1 and rate of change in functional limitations were negatively related—suggesting that higher exercise levels at time 1 were related to slower accumulation of functional limitations over time. Conclusions: Data analysis methods that allow examination of both the individual and group level of change are particularly appropriate when examining trajectories of change in persons with MS because of the highly individualized progression and presentation of the disease. Findings of this descriptive longitudinal study support the potential positive impact of exercise on the long-term progression of functional limitation and QOL for persons with MS. [Copyright &y& Elsevier]

As part of a larger clinical trial, SeniorWISE™ (Wisdom Is Simply Exploration), this study provides baseline affective, cognitive, and functional ability data and reports on the likely incidence of mild cognitive impairment (MCI) in a triethnic community sample of older adults (N = 265). Seventy-eight individuals had memory complaints, whereas 105 had none. Of the complainants, 32 had normal memory function and 46 had poor memory performance. Among those without memory complaints, 42 had no memory impairment and 63 had poor memory performance. Forty-six individuals (17%) met the criteria of poor everyday memory functioning and memory complaints whereas 81 (31%) would be considered to be at risk based on other MCI criteria. This pattern of results suggests that those with declining memory are less aware of their deficits in activities of daily living that their actual performance would suggest are occurring. [Copyright &y& Elsevier]

This study describes the menopausal experiences of women with physical disabilities and their knowledge and use of hormone replacement therapy (HRT). 166 women completed a mailed survey of demographic and disability characteristics, health history, menopausal information, and HRT knowledge. The typical respondent was a 52-year-old, Anglo, college-educated woman with a neuromuscular disorder. Half of the menopausal women were taking HRT, and 47% had a hysterectomy. HRT use was significantly associated with hysterectomy status, amount of HRT information received from providers, and regular gynecologic examinations. Effective interventions are needed to assist these women in making key health decisions during menopause. [Copyright &y& Elsevier]

and Purpose: Many breast cancer survivors (BCS) experience persistent cognitive and psychological changes associated with their cancer and/or treatment and that have limited treatment options. Therefore, the purpose of this study was to explore the feasibility and effects of a Kirtan Kriya meditation (KK) intervention on cognitive and psychological symptoms compared to an attention control condition, classical music listening (ML), in BCS. A randomized control trial design was used. Participants completed eight-week interventions. Cognitive function and psychological symptoms were measured at baseline and post-intervention. Mixed analysis of variance models were examined for all cognitive and psychological outcomes. 27 BCS completed the study. Intervention adherence was 88%. Both groups improved in perceived cognitive impairments, cognition related quality of life, verbal memory, and verbal fluency (p's < 0.01). There were no significant group by time effects for cognitive and psychological outcomes, except stress. The ML group reported lower stress at time 2 (p < 0.05). KK and ML are feasible, acceptable, and cost-effective interventions that may be beneficial for survivors' cognition and psychological symptoms. Both interventions were easy to learn, low cost, and required just 12 min/day. Meditation or music listening could offer providers evidence-based suggestions to BCS experiencing cognitive symptoms. NCT03696056. • Delivery of a remote 8-week, 12 min/day meditation and music interventions to breast cancer survivors is feasible. • Kirtan Kriya meditation may improve verbal fluency and memory, perceived cognitive functioning, and quality of life. • Music listening may improve verbal fluency and memory, perceived cognitive functioning, quality of life, and perceived stress. [ABSTRACT FROM AUTHOR]