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Social media has become an integral part of everyday life and revolutionized how older adults communicate and interact with others. The aim of the current review was to identify and synthesize quantitative studies addressing the potential relationship between social media use and depression in older adults. Medline, CINAHL, and PsycINFO databases were used to identify studies performed up to July 2020. Keywords identified were depression , social media use , and older adults . A nuanced relationship was revealed between social media use and depression in older adults. There were noted differences in the conceptualization of social media use. The reviewed studies lacked exploration of structural characteristics, examination of content, and quality of interactions in older adults' social media use. Health variables, social factors, and age cohort differences could influence the relationship between social media use and depression. Further studies are needed to enhance the understanding and explore the benefits and potential disadvantages of social media use in older adults. [ Research in Gerontological Nursing, 16 (2), 97–104.]

Background: Retinoblastoma (RB) is a malignant intraocular tumor diagnosed in early childhood that requires extensive medical and surgical treatment at a young age. Health-related quality of life (HRQOL) is thought to be diminished due to visual impairment, facial deformities, and fear of recurrence or secondary cancer. However, few studies have identified variables associated with HRQOL among those with RB. Purpose: To compare HRQOL of adolescents and young adults (AYAs) with RB to matched controls and to identify predictors of HRQOL in RB survivors. Methods: Using a cross-sectional design, 198 AYAs (101 RBs and 97 controls) completed HRQOL (PROMIS®-29 profile) and psychosocial questionnaires (Rosenberg self-esteem scale, multidimensional scale of perceived social support, and Hollingshead index for socioeconomic status). Clinical variables (age at diagnosis, visual acuity, laterality, heredity, treatment regime, and anesthesia exposure) were extracted from the medical record. Correlates of HRQOL were estimated using linear regression models. Results: RB survivors reported similar HRQOL compared to controls. Physical function ( p

Purpose To (1) Compare vision-related quality of life (VRQOL) in adolescent and young adult (AYA) unilateral versus bilateral retinoblastoma (RB) survivors using a vision-targeted measure and a generic health-related quality of life (HRQOL) measure and (2) Assess associations among VRQOL and generic HRQOL domains and overall QOL and estimate associations of the VRQOL and HRQOL domains with overall QOL. Methods The National Institute for Health (NIH) Toolbox® VRQOL instrument, PROMIS®-29 Profile v 2.1, and a single-item QOL measure were administered in a cross-sectional study of 101 RB survivors. Reliability for multi-item scales was estimated. Product-moment and Spearman rank correlation coefficients and stepwise ordinary least squares were used to measure associations of other variables with overall QOL. Results Significantly worse VRQOL was reported by bilateral than unilateral RB survivors. Cronbach’s alpha coefficients for all VRQOL scales ranged from 0.83 to 0.95. Medium to large correlations were found between all NIH Toolbox® VRQOL scales and the PROMIS®-29 measures. Depression and ability to participate in social roles and activities from the PROMIS®-29 Profile accounted for 38% of the variance in overall QOL with the psychosocial domain of the NIH Toolbox® VRQOL explaining 16% of the variance. Conclusion VRQOL is impaired in bilateral RB survivors. VRQOL is associated substantially with the PROMIS-29 generic HRQOL measure but has significant unique associations with overall QOL. The NIH Toolbox® VRQOL measure provides important information about the vision-related effects on daily life of AYA RB survivors.

Background: Unnecessary admissions fuel rising healthcare costs and take away resources from higher acuity patients without evidence of increased safety. Purpose: The purpose of this quality improvement project was to determine if the care diversion for transient ischemic attack (TIA), from inpatient to a nurse practitioner (NP)-led specialty clinic, resulted in no increase in stroke incidence at 90 days. Methods: The sample included all adults (18 years or older) presenting to the emergency department (ED) with TIA at low-to-moderate risk for stroke. Risks were defined by the ABCD 2 score and non-invasive vessel imaging. Patients who met the criteria were discharged and evaluated by a stroke NP at the TIA clinic within seven days. These patients were compared to those who were admitted to the hospital prior to clinic launch. Chart reviews were conducted to determine stroke incidence at 90 days post TIA. Descriptive statistics were used to evaluate clinical variables, and Fisher’s Exact test was used to assess difference in stroke rates. Patient satisfaction score was collected using the existing institutional survey. Results: Eighty-one participants were included, 40 in the clinic group and 41 in the admission group. The mean ages in the clinic group and the admission group were 72.8 and 75.2 years, respectively ( p =0.37). Females comprised 45% of patients in the clinic group, compared to 51.2% in the admission group ( p =0.58). The mean ABCD 2 scores were 4.08 and 3.95 in the clinic and admission groups, respectively ( p= 0.63). The median clinic follow-up time was six days. There was no stroke incidence in the clinic group and one incidence in the admission group ( p =1.0) within 90 days of index TIA. Patient satisfaction score of the NP was 92.6%. Conclusions: In conclusion, referral to an NP-led clinic in patients with low-to-moderate risk TIA was equally safe as hospital admission.

Sickle cell disease is an inherited haematological condition with life-threatening consequences. It can affect all aspects of the lives of children with the condition, including biopsychosocial and cognitive aspects. These children tend to have a low health-related quality of life (HRQoL).To identify factors associated with HRQoL in Omani children with sickle cell disease.The study was a secondary analysis of data from a randomised controlled trial conducted with 72 parent-and-child dyads who were recruited from two tertiary hospitals in Oman. The aim of the original study was to examine the effects of an educational programme on the knowledge and self-efficacy of parents of children with sickle cell disease. As part of that study, parents and children completed two questionnaires on HRQoL, one generic and one specific to sickle cell disease.Parents' knowledge of sickle cell disease, parents' self-efficacy in managing their child's symptoms, parents' age, children's age and treatment with hydroxyurea were found to affect children's HRQoL.Healthcare providers need to include biopsychosocial and cognitive aspects of HRQoL in their assessments of children with sickle cell disease. Programmes designed to enhance parents' and children's knowledge and self-efficacy, as well as measures designed to ensure that children receive treatment with hydroxyurea, are likely to improve the HRQoL of children with sickle cell disease.

Despite higher rates of hookah (i.e., waterpipe) tobacco smoking among sexual minority (SM) adults, little is known on concurrent substance use, including alcohol or other drugs, among SM hookah smokers as compared to their heterosexual counterparts. Utilizing data from the Population Assessment of Tobacco and Health Study (2013–2015), weighted analyses compared concurrent substance use among current SM adult hookah smokers versus heterosexuals. Findings revealed that SM hookah smokers had a higher prevalence of concurrent alcohol, marijuana and other drug use, including stimulants and sedatives, than heterosexuals (p < 0.05). As compared to heterosexuals, SM women and young adult (18–24 years old) smokers had higher odds of marijuana use (Women: Wave 1 odds ratio (OR), 2.16, [95% CI = 1.30–3.60]; Wave 2 OR, 2.67 [95% CI = 1.36–5.25]); young adults: Wave 1 OR, 1.55, [95% CI = 0.99–2.43]; Wave 2 OR, 2.19, [95% CI = 1.22–3.94]). In this population-based, representative sample of U.S. adults, concurrent hookah smoking and substance use differed between SM and heterosexuals. Sexual minority women and young adult hookah tobacco smokers were at increased risk for concurrent marijuana use, increasing the risk for health-related consequences in this group vulnerable to tobacco and substance use.

Purpose Many public institutions and settings have taken action to limit exposure to and slow the spread of the novel coronavirus (COVID-19). We sought to characterize the impact of stay-at-home orders on our study of cerebral autoregulation and its association with developmental delays in infants with congenital heart disease compared with healthy controls. Design and methods We calculated the number of participants recruited (i.e., not enrolled in the study) and assessed (i.e., currently enrolled) before March 2020 (pre-COVID-19) and the number of participants that we could not recruit or assess between March and July 2020 (missed due to COVID-19), separately for congenital heart disease and healthy control infants, in reference to the impacts of COVID-19. We used negative binomial regressions to determine incidence rate ratios which compared participants recruited and assessed pre-COVID-19 and missed due to COVID-19. Results Recruitment and assessments significantly decreased following the pandemic, i.e., participants were more likely to be recruited or be assessed pre-COVID-19 compared to during the pandemic. Study participants were 3.3 times as likely to have assessments performed pre-COVID-19 compared to during the COVID-19 pandemic (p Clinical implications Clinical research teams may consider making protocol modifications such as virtual visits or video recordings explaining the study, for example, to adjust to the restrictions caused by COVID-19. Conclusion The COVID-19 pandemic drastically reduced recruitment and assessments completed in our study. Study teams will need to continue to modify procedures for recruitment and assessments that align with COVID-19 regulations to facilitate research progress during the pandemic.

BACKGROUND: Unnecessary admissions fuel rising healthcare costs and take away resources from higher acuity patients without evidence of increased safety. The purpose of this quality improvement project was to determine whether the care diversion for transient ischemic attack (TIA), from inpatient to a nurse practitioner (NP)-led specialty clinic, resulted in no increase in stroke incidence at 90 days. METHODS: The sample included all adults presenting to the emergency department with TIA at a low-to-moderate risk for stroke. Risks were defined by the ABCD 2 score and noninvasive vessel imaging. Patients who met the criteria were discharged and evaluated by a stroke NP at the TIA clinic within 7 days. These patients were compared with those who were admitted before clinic launch. Medical record reviews were conducted to determine stroke incidence at 90 days post TIA. Descriptive statistics were used to evaluate clinical variables, and Fisher exact test was used to assess difference in stroke rates. Patient satisfaction score was collected using the existing institutional survey. RESULTS: Eighty-one participants were included, 40 in the clinic group and 41 in the admission group. The mean ages in the clinic and admission groups were 72.8 and 75.2 years, respectively ( P = .37). Women comprised 45% of patients in the clinic group, compared with 51.2% in the admission group ( P = .58). The mean ABCD 2 scores were 4.08 and 3.95 in the clinic and admission groups, respectively ( P = .63). The median clinic follow-up time was 6 days. There was no stroke incidence in the clinic group and 1 in the admission group within 90 days post TIA. Patient satisfaction score metrics for the NP exceeded the institutional benchmark of 90%. CONCLUSION: Referral to an NP-led clinic in patients with low- to moderate-risk TIA was equally safe as hospital admission.

Cognitive impairment is common in patients with type 2 diabetes mellitus (T2DM) and negatively impacts effective diabetes self-care. However, it is unclear whether self-care level can predict cognition status in T2DM patients. We aimed to identify self-care scores that would provide information on the patients’ cognition status. Methods: We collected diabetes self-care and cognition data from 50 T2DM patients (age 55.9±7.6 years, diabetes duration 10.1±8.2 years, A1C 7.1±1.4%, 54% female) using the Scale for Summary of Diabetes Self-Care Activities Assessment (SDSCA) and the Montreal Cognitive Assessment (MoCA) . A mixed effects logistic regression model for repeated measures used both baseline and 6 months follow-up observations with adjustment for within-subject correlation (SAS GLMMIX) . First, from nine potential covariates, an iterative backward elimination process selected a parsimonious subset of covariates for predicting MoCA level (normal vs. impairment) , optimizing area under the curve (AUC) . Four covariates were identified (education, income, ethnicity, sleep quality; AUC=.75) . Then an iterative process calculated AUC for MoCA level predicted from self-care level, using each possible self-care score cut point from .to 6.95 in .increments, controlling for the four identified covariates. An optimal cut point was selected that produced the highest AUC value. Results: The optimal self-care cut point was 2.95 (AUC=.76) , producing good discrimination of MoCA level. As a sensitivity analysis, the second best cut point of 3.95 produced AUC=.75. Conclusion: Self-care cut points, accounting for education, income, ethnicity, and sleep quality, could be used to gain information on T2DM patients’ cognition status, which may prompt clinicians and researchers to further evaluation with formal cognitive tests. Disclosure S.E.Choi: None. M.Freeby: Research Support; Abbott Diabetes, Novo Nordisk. B.Roy: None. M.A.Woo: None. R.Kumar: None. M.Brecht: None. Funding National Institutes of Health (RNR017190)

Introduction Cigarette smoking is strongly associated with the development of cardiovascular disease (CVD). However, evidence is limited as to whether smokeless tobacco (ST) use is associated with CVD. Aims and Methods Using data from 4347 adults in the Population Assessment of Tobacco and Health Study (2013–2014), we compared geometric mean concentrations of CVD-related harm biomarkers and biomarkers of exposure among exclusive ST users and exclusive cigarette smokers—in relation to recent nicotine exposure—and never tobacco users, adjusting for age, sex, race/ethnicity, income, body mass index, and CVD. Biomarker levels among exclusive ST users who were former established cigarette smokers were compared with exclusive cigarette smokers. Results Compared with cigarette smokers, ST users had significantly higher concentrations of total nicotine equivalents (TNE) but lower concentrations of inflammatory (high-sensitivity C-reactive protein, interleukin-6, intercellular adhesion molecule, fibrinogen) and oxidative stress (8-isoprostane) biomarkers (all p < .05). Biomarker levels among ST users were similar to never smokers. ST users who were former cigarette smokers had lower levels of inflammatory and oxidative stress biomarkers and biomarkers of exposure (cadmium, lead, 1-hydroxypyrene, acrylonitrile, and acrolein), compared with cigarettes smokers (p < .05), despite having higher TNE levels (p < .05). Among cigarette smokers, but not among ST users, inflammatory biomarkers and TNE were highly correlated. Conclusions ST use is not associated with increases in biomarkers of CVD-related harm and exposure, compared with never smokers, despite exposure to nicotine at levels higher than those observed among cigarette smokers. These findings support the concept that increases in CVD risk among cigarette smokers is caused primarily by constituents of tobacco smoke other than nicotine. Implications Despite having higher levels of nicotine and compared with exclusive cigarette smokers, exclusive ST users (including those who were former cigarette smokers) had significantly lower concentrations of inflammatory and oxidative stress biomarkers, comparable to levels observed among never tobacco users. These findings suggest that increases in CVD risk among cigarette smokers is caused primarily by tobacco constituents other than nicotine and that switching to ST is likely associated with lower CVD risk.

Purpose The purpose of this study was to investigate factors associated with receiving diabetes spousal support in a sample of Korean immigrants with type 2 diabetes (T2DM) and to test whether disclosure (culture-specific factor) is a significant predictor of spousal support receipt in this group. Methods A cross-sectional survey was conducted with a convenience sample of 136 US community-dwelling Korean immigrants with T2DM ages 46 to 89 years old. Potential predictors were sociodemographic factors (age, gender, education, years in US), personal characteristics (quality of marriage and depression), diabetes severity (duration of diabetes, A1C, insulin use), diabetes self-management, diabetes worries/concerns (psychological factor), and disclosure of worries (cultural factor). The study used validated survey instruments including Diabetes Care Profile for spousal support received, Summary of Diabetes Self-Care Activities, Problem Area in Diabetes, and Diabetes Distress Disclosure Index. Descriptive statistics, correlations, and hierarchical multivariable linear regression models were conducted. Results Six predictors (education level, years spent in the US, glucose control status, diabetes self-management level, diabetes worries/concerns, and disclosure of diabetes worries) were significantly related to receiving spousal support. At least some college education, less time in the US, better glucose control (lower A1C), poor self-management, more diabetes worries, and more disclosure of diabetes worries/distress were associated with receiving higher level of spousal support. Disclosure was the strongest predictor. Conclusion Receiving spousal support for diabetes self-management among Korean immigrants is influenced by 6 factors identified in this study. Disclosing diabetes worries (cultural factor) is most impactful.

Background Traditional hookah smoking has grown quickly to become a global tobacco epidemic. More recently, electronic hookahs (e-hookahs)—vaped through traditional water pipes—were introduced as healthier alternatives to combustible hookah. With combustible tobacco smoking, oxidative stress, inflammation, and vascular stiffness are key components in the development and progression of atherosclerosis. The comparable effects of hookah are unknown. Research Question What is the differential acute effect of e-hookah vaping vs combustible hookah smoking on oxidation, inflammation, and arterial stiffness? Study Design and Methods In a randomized crossover design study, among a cohort of 17 healthy young adult chronic hookah smokers, we investigated the effect of e-hookah vaping and hookah smoking on measures of conduit arterial stiffness, including carotid-femoral pulse wave velocity (PWV), augmentation index-corrected for heart rate before and after a 30-min exposure session. We assessed a panel of circulating biomarkers indicative of inflammation and oxidants and measured plasma nicotine and exhaled carbon monoxide (CO) levels before and after the sessions. Results e-Hookah vaping tended to lead to a larger acute increase in PWV than hookah smoking (mean ± SE: e-hookah, +0.74 ± 0.12 m/s; combustible hookah, +0.57 ± 0.14 m/s [P < .05 for both]), indicative of large artery stiffening. Compared with baseline, only e-hookah vaping induced an acute increase in augmentation index (e-hookah, +5.58 ± 1.54% [P = .004]; combustible hookah, +2.87 ± 2.12% [P = not significant]). These vascular changes were accompanied by elevation of the proinflammatory biomarkers high-sensitivity C-reactive protein, fibrinogen, and tumor necrosis factor α after vaping (all P < .05). No changes in biomarkers of inflammation and oxidants were observed after smoking. Compared with baseline, exhaled CO levels were higher after smoking than after vaping (+36.81 ± 6.70 parts per million vs –0.38 ± 0.22 parts per million; P < .001), whereas plasma nicotine concentrations were comparable (+6.14 ± 1.03 ng/mL vs +5.24 ± 0.96 ng/mL; P = .478). Interpretation Although advertised to be “safe,” flavored e-hookah vaping exerts injurious effects on the vasculature that are, at least in part, mediated by inflammation. Trial Registry ClinicalTrials.gov; No.: NCT03690427; URL: www.clinicaltrials.gov, Graphical Abstract

Introduction: Electronic nicotine delivery systems (ENDS) are growing quickly in the United States, particularly among youth. Electronic (e-) hookahs are a new category of vaping devices in which the e-bowl is combined with and placed on a traditional waterpipe, allowing the flavored aerosol to pass through a water-filled base before being carried through the hose into the user’s mouth. E-hookah vaping with flavored nicotine acutely impairs endothelial function. However, the relative contribution of flavorings vs. nicotine on e-hookah vaping associated vascular dysfunction is unclear. Methods: In a randomized cross-over design study, we investigated the acute effect of flavored e-hookah with and without nicotine and sham vaping, among a cohort of 9 healthy young adult chronic hookah smokers (27±1 years, mean ±SE), on endothelial function, measured by brachial artery flow-mediated dilation (FMD). Fibrinogen, a major plasma protein coagulation factor, as well as smoking exposure biomarkers (plasma nicotine and expired carbon monoxide levels) were collected before and after the sessions. Results: Vaping e-hookah with nicotine induced an acute reduction in FMD (from 6.9±0.9 to 5.2±0.8%, pre- vs. post- vaping, p Conclusions: In healthy young adults, our findings to date suggest that while vaping e-hookah with nicotine induces an unfavorable effect on the vasculature, non-nicotine constituents generated from heating the flavored e-hookah aerosol cannot be ignored. Further plans are needed to elucidate the long-term vascular implications of vaping non-nicotine flavored constituents.

Soccer participation in the United States (U.S.) has increased over time, and injuries as well as interest to prevent injuries has become more common. This study described Emergency Department (ED) visits related to concussions, intracranial injuries (ICI), and all-other injuries attributed to soccer play; described healthcare cost and length of hospital stay of soccer-related injuries; and determined independent predictors of concussions, ICI, and all-other soccer injuries leading to ED visits. The study examined soccer-related weighted discharge data from the Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Weighted tabular analysis of univariate and bivariate analyses and weighted and adjusted logistic regression models were conducted. A total of 480,580 of U.S. ED visits related to soccer injuries were available for analysis between 2010 to 2013. Generally, 98% of soccer-related ED visits resulted in routine (treat-and-release) visits. However, the odds of transfer to a short-term hospital following ED evaluation and treatment was more than 37-fold higher for soccer-injured youth and adults diagnosed with ICI when compared to all-other soccer injuries; additionally, these patients showed 28-fold higher odds of being admitted for inpatient care at the ED-affiliated hospital. For concussion, soccer-injured patients with concussion showed nearly 1.5-fold higher odds of being transferred to a short-term hospital than did those with any other soccer injury. Soccer-related ED visits cost more than 700 million in U.S. dollars from 2010 to 2013. Notable differences were noted between concussions, ICI, and all-other soccer injuries presenting to U.S. ED. Albeit underestimated given that this study excludes other forms of health care and treatment for injuries, such as outpatient clinics, over the counter medications and treatment, and rehabilitation, healthcare cost associated with soccer-related injuries presenting to ED is high, and remarkably costly in those with an ICI diagnosis.

Author(s): Lei, Fang; Chen, Wei-Ti; Brecht, Mary-Lynn; Zhang, Zuo-Feng; Lee, Eunice | Abstract: BackgroundThe uptake of cancer screening is significantly associated with participants' health beliefs about cancer screening. Scales measuring health beliefs of cancer screening are available; however, the scales that were developed and validated for the US population may lack cultural appropriateness, which could compromise the reliability and validity of the scales when applied to different ethnic groups or populations.ObjectiveThe aim of this study was to summarize, analyze, and compare the methods used in the cross-cultural instrument adaptation and validation processes of health beliefs about cancer screening.MethodsA systematic review design with narrative methods was used. Electronic databases, including PubMed, Google Scholar, CINAHL, and PsycINFO, were searched.ResultsA total of 18 articles were eligible. Results showed (1) the translation methods included committee translation and back translation, which were further refined by using professional translators, using professional interpreters and/or involving the first author, using bilingual individuals, and involving bilingual investigators; (2) the modification methods included embedded and afterward modification; and (3) the validation methods included testing construct validity, internal consistency reliability, item-total subscale correlations, test-retest reliability, content validity, predictive validity, and face validity.ConclusionsBack translation and afterward modification were most frequently used for translating existing instruments to another language. Validity and reliability were most frequently established by construct validity, content validity, face validity, predictive validity, internal consistency reliability, test-retest reliability, and item-total subscale correlation after instruments were translated.Implications for practiceClinicians should evaluate the translation and adaptation process for translated versions of instruments before using them to provide culturally appropriate and sensitive care.

Author(s): An, Eunjoo; Irwin, Michael R; Doering, Lynn V; Brecht, Mary-Lynn; Watson, Karol E; Corwin, Elizabeth; Macey, Paul M | Abstract: Background and aimsHTN affects nearly 50% of U.S. adults and is the leading modifiable cardiovascular risk factor. A healthy diet and exercise can improve BP control, but adherence to these interventions is low. We tested whether a multimodal mind-body program, Mindful Awareness Practices (MAP) could improve BP and lifestyle behaviors associated with HTN when compared to a Health Promotion Program (HPP).MethodsAdults with BP g120/80 were randomized to MAP or HPP. Outcome measurements of BP, self-reported diet, and exercise were analyzed with intent-to-treat group comparisons using repeated measures linear mixed models.ResultsThere was an MAP-HPP between-group difference in interactions of time-by-systolic BP (Pn= 0.005) and time-by-diastolic BP (Pn= .003). The mean drops in SBP from baseline to week 13 for the MAP group was 19 mm Hg (138 ± 15 mm Hg-119 ± 6 mm Hg) compared to 7 mm Hg (134 ± 18 mm Hg-127 ± 22 mm Hg) in the HPP group. Similarly, a greater reduction in DBP was observed in the MAP group compared to the HPP group, 12 mm Hg (89 mm Hg ± 11-77 ± 7 mm Hg) and 1 mm Hg (81 ± 16 mm Hg-80 ± 18 mm Hg), respectively. Mediational analysis of the MAP group showed the total effect of mindfulness practice minutes on SBP with indirect effect (ab) of -.057 was significant, resulting in a 40% lower SBP for total effect (c) compared to direct (c') effect alone. The mediational model suggests MAP has a modest positive influence on participants initiating lifestyle behavior change, which partially explains the greater reduction in BP by the MAP group.ConclusionOur findings suggest a multimodal mind-body program involving mindfulness practice may improve BP control in adults with HTN.

ENDS are evolving quickly with increasing use in the U.S. More recently, e-hookahs have been introduced as healthier alternatives to the traditional hookah-flavored tobacco smoking. To date, virtually all studies of ENDS have focused on e-cigarettes; consequently, little is known about e-hookah use.Data were drawn from the 2014-2015 Wave 2 Population Assessment of Tobacco and Health study, a nationally representative sample of adults aged ≥18 years (n=28,362) and youth aged 12-17 years (n=12,172). Weighted analyses, conducted in 2018-2019, estimated the prevalence of e-hookah versus e-cigarette and examined comparisons among users and sociodemographics, patterns of use, and co-use of tobacco products and substances.Overall, 4.6% of adults reported ever e-hookah use; of these, more than a quarter (26.8%) reported current use. For e-cigarettes, 22.5% reported ever use with 24.8% reporting current use. Among youth, 7.7% reported ever e-hookah use versus 14.3% for e-cigarette use. Comparing e-hookah versus e-cigarette only users, the majority were young adults aged 18-24 years versus ≥25 years (60.5% vs 17.3%, p0.0001) with the majority being female (58.8% vs 46.0%, p0.0001). Although alcohol and marijuana were the most common substances used among e-hookah and e-cigarette users, both adult and youth e-hookah only users had a higher prevalence of use than e-cigarette only users.Although e-hookahs are used less commonly than e-cigarettes, e-hookah use is not rare. Compared with e-cigarette users, e-hookah users have a different profile in terms of user demographics and co-use of substances. Given the rapid uptake of ENDS by young adults, these findings suggest the need to understand e-hookah products' distinct characteristics and users' smoking patterns and behaviors to help inform tobacco regulation specific to hookah.

Background: Spontaneous preterm delivery (sPTD) is associated with a twofold increased risk of future maternal cardiovascular disease. We hypothesized that women with sPTD would demonstrate greater vascular dysfunction postpartum compared to women with term delivery. Materials and Methods: In a case-controlled, matched pilot study, we enrolled 20 women with sPTD (gestation ≤34 weeks), and 20 term control women (gestation ≥39 weeks) were matched for age (±5 years), parity, ethnicity, and route of delivery. Vascular function, serum lipids, C-reactive protein, and interleukin-6 were completed within 24–72 hours postpartum. Statistical analysis included paired t-tests based on match and mixed effects linear regression models and adjusted for potential confounders. Results: The mean age for sPTD and term controls was 33 ± 6 years and 32 ± 6 years, respectively. Women with sPTD had significantly lower augmentation index-75 (24.1% ± 16.1% vs. 39.9% ± 15.2%, p = 0.001) and central pulse pressure (29.1 ± 5.4 mmHg vs. 34.6 ± 4.7 mmHg, p = 0.004), but no difference in pulse wave velocity (5.1 ± 1.6 m/s vs. 5.6 ± 1.5 m/s, p = 0.12) compared to controls. Women with sPTD had significantly lower high-density lipoprotein cholesterol (59.4 ± 12.5 mg/dL vs. 67.6 ± 13.1 mg/dL, p = 0.035) compared to controls. Analysis of chorioamnionitis and magnesium sulfate did not alter the results. Conclusions: Women with sPTD have signs of lower smooth muscle tone in the early postpartum period compared to women with term delivery. Further research is required to understand mechanistic pathways in sPTD and future maternal cardiovascular disease risk.

Frailty is a deficit accumulation in physical, psychological and social domains. Correlates of frailty were explored among formerly incarcerated, homeless women (N=130, M(age) = 38.9). Significant correlates of physical frailty were age, years homeless, prior violence, witnessing less violence, drug dependence, PTSD symptoms and tangible support. Significant correlates of psychological frailty were age, years homeless, witnessed violence, jail time, divorced less, drug use/dependence, prison time, methamphetamine use, and bodily pain. Significant correlates of social frailty were drug use, emotional regulation, and daily alcohol use. Reentry interventions are needed for formerly incarcerated, homeless women who experience physical, psychological and social frailty.

Background Tobacco smoking using a hookah (i.e., waterpipe) is a global epidemic. While evidence suggests that sexual minorities (SM) have higher odds of hookah use compared to heterosexuals, little is known about their hookah use patterns and transitions. We sought to examine transitions between hookah smoking and use of other tobacco and electronic (e-) products among SM adults aged 18 years of age and older versus their heterosexual counterparts. Methods We analyzed nationally representative data of ever and current hookah smokers from Wave 1 (2013–2014; ever use n = 1014 SM and n = 9462 heterosexuals; current use n = 144 SM and n = 910 heterosexuals) and Wave 2 (2014–2015; ever use n = 901 SM and n = 8049 heterosexuals; current use n = 117 SM and n = 602 heterosexuals) of the Population Assessment of Tobacco and Health Study. Comparisons between groups and gender subgroups within SM identity groups were determined with Rao-Scott chi-square tests and multivariable survey-weighted multinomial logistic regression models were estimated for transition patterns and initiation of electronic product use in Wave 2. Results Ever and current hookah smoking among SM adults (ever use Wave 1: 29% and Wave 2: 31%; current use Wave 1: 4% and Wave 2: 3%) was higher than heterosexuals (ever use Wave 1: 16% and Wave 2: 16%; current use Wave 1: 1% and Wave 2: 1%; both p Conclusions Compared to heterosexuals, in addition to higher rates of hookah smoking, higher percentages of SM adults transitioned to hookah plus e-product use between 2013 and 2015. Results have implications for stronger efforts to increase awareness of the harmful effects of hookah as well as vaping, specifically tailored among SM communities.

Additional file 1: Supplemental Table 1. Sociodemographic Predictors of Ever and Current Hookah Use Waves 1 and 2 (2013-2014). Supplemental Table 2. Sociodemographic Predictors for Wave 1 Hookah-Only Users Transition Patterns. Supplemental Table 3. Sociodemographic Predictors of Transition Patterns Wave 1 to Wave 2 (Including Uptake of E-Products)

BACKGROUND Rapid reperfusion reduces infarct size and mortality for acute coronary syndrome (ACS), but efficacy is time dependent. The aim of this study was to determine if transportation factors and clinical presentation predicted prehospital delay for suspected ACS, stratified by final diagnosis (ACS vs. no ACS). METHODS A heterogeneous sample of emergency department (ED) patients with symptoms suggestive of ACS was enrolled at 5 US sites. Accelerated failure time models were used to specify a direct relationship between delay time and variables to predict prehospital delay by final diagnosis. RESULTS Enrolled were 609 (62.5%) men and 366 (37.5%) women, predominantly white (69.1%), with a mean age of 60.32 (±14.07) years. Median delay time was 6.68 (confidence interval 1.91, 24.94) hours; only 26.2% had a prehospital delay of 2 hours or less. Patients presenting with unusual fatigue [time ratio (TR) = 1.71, P = 0.002; TR = 1.54, P = 0.003, respectively) or self-transporting to the ED experienced significantly longer prehospital delay (TR = 1.93, P < 0.001; TR = 1.71, P < 0.001, respectively). Predictors of shorter delay in patients with ACS were shoulder pain and lightheadedness (TR = 0.65, P = 0.013 and TR = 0.67, P = 0.022, respectively). Predictors of shorter delay for patients ruled out for ACS were chest pain and sweating (TR = 0.071, P = 0.025 and TR = 0.073, P = 0.032, respectively). CONCLUSION Patients self-transporting to the ED had prolonged prehospital delays. Encouraging the use of EMS is important for patients with possible ACS symptoms. Calling 911 can be positively framed to at-risk patients and the community as having advanced care come to them because EMS capabilities include 12-lead ECG acquisition and possibly high-sensitivity troponin assays.

Introduction: Rapid reperfusion reduces infarct size and mortality for acute coronary syndrome (ACS) but efficacy is time dependent. Time to presentation in the Emergency Department (ED) remains excessive and patient-controlled prehospital delay may be a modifiable variable for intervention. The aim of the study was to determine if transportation factors and clinical presentation predicted prehospital delay for suspected ACS stratified by final diagnosis (ACS vs. no ACS). Hypothesis: Symptoms other than chest pain would contribute to longer prehospital delay that would vary by final diagnosis. Methods: Secondary analysis of data collected from a multi-center prospective study. A heterogeneous sample of ED patients with symptoms suggestive of ACS were enrolled at five sites in the US. Accelerated failure time (AFT) models were used to specify a direct relationship between delay time and variables to predict prehospital delay by final diagnosis. Results: The sample of 975 adults included 609 (62.5%) men and 366 (37.5%) women who were predominantly Caucasian (69.1%), had a mean age of 60.32 (±14.07) years, and had lower income levels (66.4% ≤$50,000 annually). Median delay time was 6.68 (1.91, 24.94) hours and only 26.2% had a prehospital delay of 2 hours or less. Patients with and without ACS presenting with unusual fatigue (TR=1.71, p=0.002; TR=1.54, p=0.003 , respectively) or self-transporting to the ED experienced significantly longer prehospital delay (TR 1.93, pp , respectively). Predictors of shorter delay in patients with ACS were shoulder pain and lightheadedness (TR=0.65, p =0.013 and TR=0.67, p =0.022, respectively). Predictors of shorter delay for patients ruled-out for ACS were the presence of chest pain, sweating (TR=0.071, p =0.025 and TR=0.073, p =0.032, respectively). Conclusion: Patients self-transporting to the ED had prolonged prehospital delays. Encouraging the use of EMS is an important modifiable factor for patients with symptoms concerning for ACS. Calling 911 can be positively framed to at risk patients and the community as having advanced care come to them since EMS diagnostic capabilities include 12-lead ECG acquisition and possibly high sensitivity troponin assays.

Introduction: Insufficient physical activity (PA) and obesity-related health conditions have reached epidemic proportions worldwide. Mexican American women (MAW) report low leisure time physical activity. Few studies examine activities beyond leisure time. Qualitative research suggests that partner support influence provides a cultural approach relevant to PA among MAW. Method: This cross-sectional study used an ecological model to investigate community (the physical environment), interpersonal (partner support, attitudinal familism), and intrapersonal (age, health conditions, acculturation, employment, and body mass index) factors associated with PA among 112 MAW. Community-based participatory research recommendations guided the preparatory phase of the study and the face-to-face interviews. Frequencies and descriptive statistics were computed. Multivariable linear regression analyses were used to examine associations between study variables. Results: Moderate to high PA levels were found based on combined activities performed during leisure time, transportation, household tasks, and occupational duties. Women with greater partner support reported higher PA levels. Although acculturation levels were low among women, those with higher acculturation were found to be more physically active. Conclusions: Future studies should examine strategies to increase partner support and address acculturation within intervention programs to enhance overall PA among MAW.

Background Sickle cell disease (SCD) is a genetic blood disorder that increases the risk for recurrent painful episodes. Parents’ knowledge regarding SCD management is poor, leading to poor symptom management and lower Health Related Quality of Life (HRQOL) in children with SCD. The purpose of this study was to examine the effects of a parent educational intervention program ( PEIP ) on the parental knowledge, self-efficacy and perception of the HRQOL of their children with SCD.Methods Two groups of Omani parents of children with SCD were randomly assigned to either an experimental group (n=37) receiving PEIP accessed on a smartphone + weekly phone reinforcement for four weeks, or a control group (n=35) receiving Standard Educational Program (SEP) as part of standard of care. Outcome measures were knowledge, self-efficacy and HRQOL of children with SCD. Knowledge Questionnaire, Self-Efficacy Scale, and HRQOL-SCD + HRQOL-GENERIC were administered twice (at enrollment, and 4 weeks after enrollment). Statistical Pakage for Social Science, version 24 was used for data analyses.Results Parents’ knowledge and self-efficacy scores were significantly higher for the intervention group (PEIP) when compared to the SEP 4 weeks post intervention. Also, The total HRQOL scores were higher at 4 weeks compared to baseline, and were also higher in the PEIP compared to the SEP. Parents’ knowledge and self-efficacy were significant predictors of HRQOL in children with SCD.Conclusions PEIP delivered by using a smartphone was effective in improving the parents’ knowledge, self-efficacy in symptom management, and parent and child perception of HRQOL. PEIP was innovative in that it targeted all dimensions of HRQOL in children with SCD. Finally, the family played an important role in the process of care and therefore, developing family-based interventions is the key factor for improving HRQOL in children with SCD. The study highlighted the effectiveness of smartphone technology for delivering a high quality educational intervention program for parents and their families.

Researchers have explored broadly the effects of military service and service-related experiences on sexual and intimate relationships among Veterans. However, descriptions of patterns of relations...

Triple-negative breast cancer (TNBC) affects only about 10-15% of women with breast cancer (BC) but accounts for almost 50% of all BC deaths. At this time, development of targeted treatments for TNBC are urgently needed. Insulin-like growth factor-2 (IGF2) is highly expressed in TNBCs and mediates its proliferative effects via two hormone receptors, insulin-like growth factor -1 receptor (IGF1R) and insulin receptor (IR). Using a TNBC tissue microarray (TMA) consisting of 159 archival clinical samples, we confirm that IGF2 is highly expressed in tumor tissue as compared to nearby normal tissue (P Citation Format: Nalo M. Hamilton, Diana Marquez-Garban, David Austin, Neda Moatamed, Lorena P. Burton, David Elashoff, Begonya Comin-Anduix, Tristan Grogan, Madhuri Wadehra, Helena Chang, Adrienne Martinez, Mary-Lynn Brecht, Isabel Jabara, Richard Pietras, Yahya Elshimali, Jaydutt Vadgama, Michael Jung. Insulin-like growth factor-2 a potential target for screening and treatment in patients with triple negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 943.

Aims To estimate the prevalence of tobacco, alcohol and drug use in Iraq using data from the Iraqi National Household Survey of Alcohol and Drug Use (INHSAD). Design A cross-sectional survey was conducted using a multi-stage cluster sampling method. Trained surveyors conducted face-to-face household interviews. Setting Iraq, from April 2014 to December 2014. Participants A total of 3200 adult, non-institutionalized Iraqi citizens residing across all 18 governorates of Iraq. Measurements We estimated weighted prevalence and 95% confidence intervals (CIs) for life-time, past-year and past-month use of a variety of substances (tobacco, alcohol, prescription drugs and illicit drugs). For each substance, we also estimated whether individuals knew people who currently use the substance. Findings Self-reported past-month tobacco use was 23.2% (95% CI = 21.40, 25.19). Past-month alcohol use was 3.2% (95% CI = 2.58, 3.93). Women reported significantly lower prevalence for both tobacco and alcohol use compared with men (P-value

Background: Retinoblastoma is a malignant tumor of the eye that typically presents in early childhood and occurs in approximately 1 in 20,000 births. While active treatment of the tumor is typically completed in childhood, survivors often suffer from long-term effects from treatment including visual impairment, facial deformities, and fear of recurrence or secondary cancer. However, little is known how these long-term effects affect their health-related quality of life (HRQOL). Purpose: To review the literature on HRQOL in retinoblastoma survivors. Method: We searched three electronic databases from January 2005 to December 2018 for original research articles reporting on HRQOL or individual domains such as function, cognition, and psychosocial outcomes in retinoblastoma survivors. Results: A total of 59 articles were reviewed and 15 were identified as eligible. Five of the studies reported worse HRQOL in retinoblastoma survivors than controls or general population norms. Parent-proxy ratings were worse than survivors’ self-reports. Conclusion: Our findings confirm the need for further HRQOL research to assess the factors influencing long-term outcomes associated with treatment in adolescent and young adult retinoblastoma survivors. By identifying any potential deficits in specific domains of HRQOL, early interventions might be developed to improve HRQOL in retinoblastoma survivors.

Our cross-sectional study examined the prevalence of cognitive impairment among people living with HIV (PLWH) aged 60 years or older. The sample, composed of 250 PLWH, was recruited from 2 clinics in Hunan, China. Structured questionnaires guided face-to-face interviews, including items addressing demographic characteristics, regimens of antiretroviral therapy, and cognitive status as measured by the Montreal Cognitive Assessment. Findings revealed cognitive function of this population was significantly lower than that of uninfected individuals based on historical comparisons; 87.2% (n = 218) of PLWH in our study had cognitive impairment. Global cognitive function as well as the domains of language and orientation decreased with age. Global cognitive function was associated with sex and education, but not with antiretroviral therapy regimens. These findings support an urgent need to include routine screening for cognitive function in older PLWH and the need to consider the complexity of the evaluation process.

Background Electronic nicotine delivery systems (ENDS) are a new rapidly growing global epidemic. More recently, electronic (e-) hookahs, have increased in popularity in the United States, with the greatest uptake by young female adults, who endorse marketing claims that these products are safer alternatives to traditional hookah tobacco smoking. Unlike other ENDS such as e-cigarettes, e-hookah bowls are used through traditional waterpipes, allowing the vapor–containing aerosolized nicotine, propylene glycol, glycerin, and flavorings–to pass through a water-filled basin, before it is inhaled through the user's mouth. Contributing to e-hookah bowls' popularity is the belief that e-hookah flavored smoke is detoxified as it passes through the water-filled basin, rendering e-hookah a safer tobacco alternative. However, an e-hookah bowl delivers flavored nicotine by creating a vapor of fine ( Purpose To test the acute effect of electronic hookah smoking on endothelial function, inflammation and oxidative stress. Methods In 17 healthy young adults who smoke hookah but not cigarettes (age 26±1 years, mean±SE; BMI 23.8±0.7 kg-m2), we measured brachial artery flow-mediated dilation (FMD) before and after a 30-minute e-hookah bowl smoking. To test for inflammatory mediation, pro-inflammatory cytokines hsCRP, TNF-α, and fibrinogen were collected before and after smoking. To test for oxidative stress mediation, on a separate day, the acute effect of e-hookah smoking on FMD was examined after intravenous infusion of Vitamin C, an effective antioxidant. Plasma nicotine levels were collected before and after the smoking session. The same measurements were performed before and after a subset of subjects (n=8) performed a sham-smoking control study. Results E-hookah smoking, which markedly increased plasma nicotine (Δ plasma nicotine: +6.07±1.87, p=0.018) and mean arterial pressure (Δ mean arterial pressure: +12±2 mm Hg, p Conclusions In contrast to the widespread popular belief that e-hookah is safe, the data herein show that each e-hookah session constitutes a potent vascular toxin acutely impairing endothelial function and inducing an inflammatory state. That the acute impairment in FMD with electronic hookah is restored with administration of the potent antioxidant Vitamin C suggest that elevated vascular oxidative stress as a key mechanism involved. These new data provide evidence to counter claims that e-hookah is a safer tobacco alternative. Acknowledgement/Funding This work was funded by the National Institutes of Health, National Heart, Lung, and Blood Institute 1R21HL145002-01 to MRH.

Supplemental Material, Appendix_A for Associations of Partner Support and Acculturation With Physical Activity in Mexican American Women by Neomie C. Congello, Deborah Koniak-Griffin, Mary-Lynn Brecht, Ron D. Hays, Mary-Sue V. Heilemann and Adeline M. Nyamathi in Hispanic Health Care International