Preventing Chronic Disease最新文献

We outline a practical approach to engaging Latino communities in dementia care research by establishing a community advisory board (CAB). Acknowledging the historical underrepresentation of Latinos in health research, we aimed to ensure that Latino perspectives and concerns were central to our research endeavors. As an initial step we adapted the Patient Advisor Toolkit 1: Orientation for Patient Advisory Committees (PAT-1) created by the Wisconsin Network for Research Support at the University of Wisconsin - Madison School of Nursing to the needs of Latino/a/e/x populations. We describe the CAB formation process, from initial outreach to community members and organizations to the recruitment, engagement, and retention of CAB members. CAB members provided guidance on the legibility and clarity of study materials and assisted with strategic planning for outreach initiatives related to healthy aging, brain health, and dementia risk reduction. Our enduring connections with CAB members and community partners have ensured that our research activities address community needs, provide benefits to the community, and inform our approach to connecting with Latinos in a culturally appropriate way. To foster successful CAB engagement and retention, we recommend 1) building trust with partners, 2) establishing clear expectations, 3) ensuring inclusive communication formats, 4) maintaining open communication, 5) offering honoraria and recognition, 6) affirming CAB members' contributions, 7) understanding power dynamics between the academic institution and the community, and 8) ensuring adequate staff and programmatic support. This approach fosters trust-based relationships and meaningful engagement that advances health equity.

Introduction: Municipalities can improve access to food through transit planning. The primary objective of this study was to describe the prevalence of public transit supports for food access among a sample of US municipalities and their association with the municipalities' sociodemographic characteristics.

Methods: This study used a nationally representative sample (N = 1,956) of US municipalities with a population of at least 1,000 that responded to the 2021 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living. We assessed 4 outcomes: public transit availability and planning, presence of demand responsive transportation (DRT), DRT services to food retail destinations (farmers markets and supermarkets), and consideration of these locations in transit planning. We used χ² tests to compare the prevalence of outcomes by municipal characteristics and multivariable logistic regression to calculate odds ratios to assess the relationship between municipal characteristics and having DRT.

Results: Approximately half (weighted 53.2%) of municipalities reported having or planning for public transit, of which 27.1% and 52.6% reported considering service to farmers markets or supermarkets, respectively. Approximately one-third (35.5%) of municipalities reported having DRT, of which 52.0% and 84.4% reported services to farmers markets or supermarkets, respectively. All outcomes significantly differed by municipal characteristics. We found higher odds of having DRT in municipalities with 2,500 to 50,000 people or more (vs <2,500 people); those with 50% or less of the population being non-Hispanic White (vs >50% non-Hispanic White); and municipalities containing low-income/low-access tracts. The odds of having DRT were lower in rural (vs urban) municipalities and in those in Northeast and South (vs the Midwest).

Conclusion: Results suggest opportunities for municipalities to use transit planning to improve food access, especially in northeastern, southern, smaller, or rural communities.

Low-income, uninsured women are disproportionately affected by cardiovascular disease (CVD). Facilitating primary and secondary prevention of CVD in this population requires supports beyond clinical and public health agencies. The Illinois WISEWOMAN Program (IWP) provides CVD prevention, screening, and management for women who lack health insurance in Illinois, including the use of referral systems to link clients to needed services. To support these efforts, the 7 local agencies implementing IWP developed linkages to facilitate participant referrals for health promotion, clinical services, and programs addressing social needs. The IWP evaluation team implemented a community resource assessment (CRA) process to describe partnerships and facilitate partnership expansion. To conduct the process, we developed a CRA template, which IWP agencies completed in 2019, 2021, and 2023 to describe community organizations that offer IWP-related resources, their relationships with these organizations, and plans to develop or maintain relationships. We tabulated data on the number of partnerships at each agency and across resource types, mapped findings, and compared data across years. We also consolidated and shared strategies for partnership development. The number of partnerships increased from 2019 (N = 179) to 2021 (N = 225), then decreased slightly to 214 by 2023. In 2023, several IWP agencies reported that partners had discontinued services due to the COVID-19 pandemic. The CRA process provides a formal structure for public health agencies to document their partners and gaps and plan for new partnerships. Additionally, the CRA process contributes to understanding the diverse contexts in which public health programs are offered and how external factors, such as COVID-19, can indirectly affect the availability of community resources.

Introduction: Peripheral artery disease (PAD) and dyslipidemia are both independent predictors of cardiovascular disease, but the association between individual lipid species and subclinical PAD, assessed by ankle-brachial index (ABI), is lacking in large-scale longitudinal studies.

Methods: We used liquid chromatography-mass spectrometry to repeatedly measure 1,542 lipid species from 1,886 American Indian adults attending 2 clinical examinations (mean ~5 years apart) in the Strong Heart Family Study. We used generalized estimating equation models to identify baseline lipid species associated with change in ABI and the Cox frailty regression to examine whether lipids associated with change in ABI were also associated with incident coronary heart disease (CHD). We also examined the longitudinal association between change in lipid species and change in ABI and the cross-sectional association of individual lipids with ABI. All models were adjusted for age, sex, body mass index, smoking, alcohol use, hypertension, estimated glomerular filtration rate, diabetes, and lipid-lowering medication.

Results: Baseline levels of 120 lipid species, including glycerophospholipids, glycerolipids, fatty acids, and sphingomyelins, were associated with change in ABI. Among these, higher baseline levels of 3 known lipids (phosphatidylinositol[16:0/20:4], triacylglycerol[48:2], triacylglycerol[55:1]) were associated with a lower risk of CHD (hazard ratios [95% CIs] ranged from 0.67 [0.46-0.99] to 0.76 [0.58-0.99]), while cholesterol was associated with a higher risk of CHD (hazard ratio [95% CI] = 1.37 [1.00-1.87]). Longitudinal changes in 32 lipids were significantly associated with change in ABI during 5-year follow-up. Plasma levels of glycerophospholipids, triacylglycerols, and glycosylceramides were significantly associated with ABI in the cross-sectional analysis.

Conclusion: Altered plasma lipidome is significantly associated with subclinical PAD in American Indians beyond traditional risk factors. If validated, the identified lipid species may serve as novel biomarkers for PAD in this high-risk but understudied population.

Introduction: Mental health conditions such as anxiety, depression, and suicidal ideation or suicide are prevalent among college students and are a growing public health concern. The COVID-19 pandemic exacerbated this crisis. Nurses are a vital component of college health services and may be the first or only health care provider to evaluate college students experiencing a mental health condition. However, the literature has limited evidence on the nurse's role and its impact on college mental health. Our systematic review examines nurse-led mental health interventions for college students.

Methods: We conducted a comprehensive search for nurse-led interventions in college mental health by using PubMed, Embase, CINAHL, PsycInfo, and ERIC databases. A total of 2,814 articles were identified, and 2,290 were screened after removal of 524 duplicates. Thirty-five studies were reviewed for eligibility, and 16 were included in this review. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Hierarchy of Evidence Guide and Appraisal Tools were used to rate the strength and quality of the evidence, and the selected articles were generally of good quality.

Results: The 16 articles came from institutions in North America (n = 5), southeastern Europe (n = 3), and Asia (n = 8). The studies focused on samples with a pre-existing mental health diagnosis or on mental health symptoms and interventions aimed at addressing mental health concerns. The interventions were facilitated by nurses and included various approaches, including experimental, quality improvement, and educational strategies.

Conclusion: This review underscores the crucial role of nurses in addressing mental health issues among college students. Despite variability in approaches, nurse-led interventions offer promise in enhancing student well-being. Further studies are essential to gauge effectiveness and shape policies for supporting the nurse's unique role in higher education. Integrating these findings into practice and policy will equip college health services to meet students' evolving needs. Leveraging the expertise of nurses can enhance student mental well-being, leading to improved academic outcomes and overall quality of life.

Introduction: Uranium is common in drinking water, soil, and dust in American Indian communities. Hypertension is a cardiovascular risk factor affecting American Indians. We evaluated the association between uranium exposure and incident hypertension and changes in blood pressure among Strong Heart Family Study participants.

Methods: We included 1,453 participants ≥14 years with baseline visits in 1998-1999 or 2001-2003, and follow-up in 2001-2003 and/or 2006-2009. We estimated the association of urinary uranium with changes in systolic and diastolic blood pressure levels over time and hypertension incidence; we accounted for family clustering.

Results: Median (IQR) baseline urinary uranium levels were 0.029 (0.013-0.059) μg/g creatinine; 17.4% (n = 253) of participants developed hypertension. In the comparison of the urinary uranium quartile 4 (highest concentration) and quartile 1 (lowest concentration), the multi-adjusted risk ratio (95% CI) of incident hypertension was 1.44 (1.04-1.99). The associations between urinary uranium with changes in systolic and diastolic blood pressure were null and nonlinear, respectively. Both associations were modified by study site, and diastolic blood pressure showed a positive association beyond 5 µg/g creatinine. The association between urinary uranium and change in systolic blood pressure was inverse in Arizona and Oklahoma, and positive in North Dakota/South Dakota at higher ends of the uranium distribution.

Conclusion: Findings suggest a higher risk for hypertension at uranium levels typical of the Southwest and Great Plains than at levels in other regions (<0.01 µg/g creatinine); the associations with changes in systolic and diastolic blood pressure levels were consistent with a positive association with higher uranium exposure. Prospective research is critical to characterize the cardiovascular effects of uranium and develop preventive strategies for US Indigenous communities disproportionately exposed.

Introduction: Chronic conditions are costly and major causes of death and disability. Addressing conditions earlier in adulthood can slow disease progression and improve well-being across the lifespan. We estimated, by life stage, 10-year trends among US adults in the prevalence of 1 or more chronic conditions, multiple chronic conditions (MCC; ≥2 conditions), and 12 selected chronic conditions.

Methods: We analyzed data from the 2013-2023 (odd years) Behavioral Risk Factor Surveillance System (N = 2,673,529). We estimated the prevalence of 1 or more conditions, MCC, and each of 12 conditions, by life stage: young (18-34 y), midlife (35-64 y), and older (≥65 y) adults. We used polynomial contrasts to analyze 10-year trends.

Results: In 2023, 76.4% (representing 194 million) of US adults reported 1 or more chronic conditions, including 59.5%, 78.4%, and 93.0% of young, midlife, and older adults, respectively. Moreover, 51.4% (representing 130 million) of US adults reported MCC, including 27.1%, 52.7%, and 78.8% of young, midlife, and older adults, respectively. Among young adults, from 2013 to 2023, prevalence increased significantly from 52.5% to 59.5% for 1 or more conditions and from 21.8% to 27.1% for MCC.

Conclusion: Approximately 6 in 10 young, 8 in 10 midlife, and 9 in 10 older US adults report 1 or more chronic conditions. Trends in conditions worsened among young adults during 2013-2023. Recognizing the burden of chronic disease throughout life stages, especially earlier in life, practitioners and partners may consider prevention and management approaches critical for addressing costs, care, and health outcomes. Practitioners may also consider tailoring these approaches to unique roles, transitions, and challenges in different life stages.

Introduction: We aimed to describe the prevalence of vitamin D deficiency among American Indian adolescents and determine its association with cardiovascular disease (CVD) risk factors.

Methods: Our study population consisted of 307 adolescents (aged ≤20 years) participating in the Strong Heart Family Study with serum 25-hydroxyvitamin D (25[OH]D) measured on samples collected during baseline examinations (2001-2003). We defined baseline prevalence of vitamin D deficiency as 25(OH)D ≤20 ng/mL. We evaluated outcomes related to obesity (BMI, waist circumference, wait-to-hip ratio, and body fat percentage), diabetes, cholesterol, and metabolic syndrome. We used generalized estimating equations to determine whether the prevalence of the outcomes differed according to vitamin D deficiency status, while controlling for covariates. To determine incidence, we conducted a follow-up examination a median 5.8 years after baseline (2006-2009) and a second follow-up a median of 13.3 years after baseline (2014-2018). We calculated incidence rates (IR) per 100 person-years for the total group and stratified by vitamin D deficiency status at baseline. Finally we used shared frailty cox proportional hazards models to determine if the risk of the outcomes differed according to vitamin D deficiency status, while controlling for covariates.

Results: The prevalence of vitamin D deficiency was 50.8% at baseline, and it was associated with the prevalence of obesity, low HDL-C, and metabolic syndrome, while controlling for covariates. By the first follow-up, the IRs per 100 person-years were the following: obesity (5.03), diabetes (1.07), any dyslipidemia (10.80), and metabolic syndrome (3.31). By the second follow-up, the IR of diabetes was significantly higher among those with (vs without) baseline vitamin D deficiency (1.32 vs 0.68 per 100 person-years; P = .02), although the association was not significant after adjusting for covariates.

Conclusion: Vitamin D deficiency in adolescence may be associated with the CVD risk factors obesity, low HDL-C, and metabolic syndrome and may also contribute to the development of diabetes later in life.

Researchers need applicable tools to analyze and account for familial relatedness when working with family study data. In this brief article, we describe the application of 2 modeling strategies for studying the association between leukocyte telomere length and incident stroke based on data collected in the Strong Heart Family Study: the shared frailty model and the marginal Cox proportional hazards model. Although these modeling strategies are based on different theoretical frameworks, their results were similar. Future simulation study may help us to better understand the limitations and performance of each strategy in a controlled environment.