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Open access publications by faculty, postdocs, and graduate students in the Department of Behavioral Health and Nutrition.
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Item Moderate Physical Activity Mediates the Association between White Matter Lesion Volume and Memory Recall in Breast Cancer Survivors(Public Library Science, 2/25/16) Cooke,Gillian E.; Wetter,Nathan C.; Banducci,Sarah E.; Mackenzie,Michael J.; Zuniga,Krystle E.; Awick,Elizabeth A.; Roberts,Sarah A.; Sutton,Brad P.; McAuley,Edward; Kramer,Arthur F.; Gillian E. Cooke, Nathan C. Wetter, Sarah E. Banducci, Michael J. Mackenzie, Krystle E. Zuniga, Elizabeth A. Awick, Sarah A. Roberts, Brad P. Sutton, Edward McAuley, Arthur F. Kramer; Mackenzie, Michael JohnIncreased survival rates among breast cancer patients have drawn significant attention to consequences of both the presence of cancer, and the subsequent treatment-related impact on the brain. The incidence of breast cancer and the effects of treatment often result in alterations in the microstructure of white matter and impaired cognitive functioning. However, physical activity is proving to be a successful modifiable lifestyle factor in many studies that could prove beneficial to breast cancer survivors. This study investigates the link between white matter lesion volume, moderate physical activity, and cognition in breast cancer survivors following treatment compared to non-cancer age-matched controls. Results revealed that brain structure significantly predicted cognitive function via mediation of physical activity in breast cancer survivors. Overall, the study provided preliminary evidence suggesting moderate physical activity may help reduce the treatment related risks associated with breast cancer, including changes to WM integrity and cognitive impairment.Item Higher cardiorespiratory fitness levels are associated with greater hippocampal volume in breast cancer survivors(Frontiers Media S.A., 2015-08-26) Chaddock-Heyman, Laura; Mackenzie, Michael J.; Zuniga, Krystle; Cooke, Gillian E.; Awick, Elizabeth; Roberts, Sarah; Erickson, Kirk I.; McAuley, Edward; Kramer, Arthur F.; Laura Chaddock-Heyman, Michael J. Mackenzie, Krystle Zuniga, Gillian E. Cooke, Elizabeth Awick, Sarah Roberts, Kirk I. Erickson, Edward McAuley and Arthur F. Kramer; Mackenzie, Michael J.As breast cancer treatment is associated with declines in brain and cognitive health, it is important to identify strategies to enhance the cognitive vitality of cancer survivors. In particular, the hippocampus is known to play an important role in brain and memory declines following cancer treatment. The hippocampus is also known for its plasticity and positive association with cardiorespiratory fitness (CRF). The present study explores whether CRF may hold promise for lessening declines in brain and cognitive health of a sample of breast cancer survivors within 3 years of completion of primary cancer treatment. We explored the role of cardiovascular fitness in hippocampal structure in breast cancer survivors and non-cancer female controls, as well as performed a median split to compare differences in hippocampal volume in relatively higher fit and lower fit cancer survivors and non-cancer controls. Indeed, CRF and total hippocampal volume were positively correlated in the cancer survivors. In particular, higher fit breast cancer survivors had comparable hippocampal volumes to non-cancer control participants (Cohen’s d = 0.13; p > 0.3), whereas lower fit breast cancer survivors showed significantly smaller hippocampal volumes compared to both lower fit and higher fit control participants (Cohen’s d = 0.87, p < 0.05). These results are the first to identify that CRF may protect the brain health of breast cancer survivors within 3 years of treatment. The present study uniquely contributes to the field of cancer and cognition and emphasizes the importance of investigating how individual differences in CRF play a role in brain changes of breast cancer survivors.Item Self-weighing behavior in individuals with eating disorders(John Wiley & Sons, Inc, 2016-03-18) Pacanowski, Carly R.; Pisetsky, Emily M.; Berg, Kelly C.; Crosby, Ross D.; Crow, Scott J.; Linde, Jennifer A.; Mitchell, James E.; Engel, Scott G.; Klein, Marjorie H.; Smith, Tracey L.; Le Grange, Daniel; Wonderlich, Stephen A.; Peterson, Carol B.; Carly R. Pacanowski, Emily M. Pisetsky, Kelly C. Berg, Ross D. Crosby, Scott J. Crow, Jennifer A. Linde, James E. Mitchell, Scott G. Engel, Marjorie H. Klein, Tracey L. Smith, Daniel Le Grange, Stephen A. Wonderlich, Carol B. Peterson; Pacanowski, Carly R.Objective To describe the frequency of self-weighing and reactions to prescribed weekly weighing among individuals with eating disorder (ED) diagnoses, and to compare individuals weighing more or less frequently on mass index (BMI) and the Eating Disorder Examination (EDE) subscales. Method Baseline EDE and demographics from five studies (N = 758). Results Self-weighing was most frequent among individuals with anorexia nervosa (AN), followed by those with bulimia nervosa (BN) and binge eating disorder (BED). On average, participants reacted moderately negative to prescribed weekly weighing. No relationship between weighing frequency and BMI was evident in any sample. There was indication of greater pathology (i.e., restraint, shape concern, weight concern, global) in AN with more frequent weighing. In BN, mixed evidence emerged to support a relationship between more frequent weighing and higher shape concern, weight concern, and global score. In BED, higher restraint was found in those who weighed versus those who did not. Discussion Weighing frequency in each eating disorder (ED) sample was to some extent associated with greater ED severity, but not BMI. Future research should examine relationships between self-weighing, reactions to changing weighing frequency, and ED symptomatology in both ED and non-ED groups to understand the impact of self-weighing in heterogeneous populations.Item Effects of resistance training interventions on muscular strength in adults with intellectual disability: a systematic review and meta-analysis(Disability and Rehabilitation, 2021-04-17) Obrusnikova, Iva; Firkin, Cora J.; Cavalier, Albert R.; Suminski, Richard R.Purpose: Muscular strength is critical for adults with an intellectual disability (ID) to promote their mobility, cardiovascular capacity, and performance of daily living/recreational/vocational activities. This article reports the results of the first systematic review and meta-analysis of peer-reviewed clinical trials that evaluated the effects of resistance training (RT) interventions on muscular strength in adults with ID. Methods: The protocol was registered with PROSPERO (CRD42020184905). The review focuses on clinical trials that recorded quantitative measures of maximum muscular strength. Eleven electronic databases were searched from their earliest available record up to May 2020. After screening 1996 search records, 11 clinical trials were reviewed. Results: The RT interventions, while heterogeneous, had an overall significant (p ≤ 0.05) effect on muscular strength in adults with ID, ages 25–58 years. The findings were more significant and less heterogeneous for non-combined RT interventions than for interventions that combined RT exercises with aerobic or balance exercises. The TESTEX overall score was 8.3 ± 3.6. Conclusions: RT interventions (particularly when not combined with other exercises) are effective in promoting muscular strength in adults with ID. The limited number of studies and the low study quality scores indicate a potential risk of bias, which limits the interpretation of the findings and warrants further investigation. IMPLICATIONS FOR REHABILITATION: Muscular strength is critical for adults with an intellectual disability (ID) to promote their mobility, cardiovascular capacity, and performance of daily living/recreational/vocational activities. RT interventions are an effective means of improving muscular strength in adults with ID, especially when not combined with other forms of exercise. Testing and assessment protocols used in RT programs should be individualized for adults with ID to accommodate their characteristics and should be implemented under conditions similar to those experienced during the training regimen. It is important to implement familiarization sessions before carrying out muscular strength testing or initiating an RT program to ensure safety, accuracy, and effectiveness of the program for adults with ID.Item A Qualitative Study of the COVID-19 Response Experiences of Public Health Workers in the United States(Health Security, 2021-12-17) Scales, Sarah E.; Patrick, Elizabeth; Stone, Kahler W.; Kintziger, Kristina W.; Jagger, Meredith A.; Horney, Jennifer A.The mental health impacts of the COVID-19 pandemic on frontline, patient-facing healthcare staff have been described in several studies, but the effects of the COVID-19 response on the US public health workforce have not been well characterized. In early 2021, we conducted interviews with a subset of public health practitioners in the United States who participated in a cross-sectional survey and indicated their willingness to participate in a follow-up interview. An interview guide was developed to collect information about professional roles since the start of the pandemic, aspects of the individual COVID-19 response that impacted mental health, and aspects of the organizational/institutional COVID-19 response that impacted mental health, as well as the strengths and weaknesses of, opportunities for, and threats to public health professionals and organizations going forward. Interviews were transcribed and inductively coded to identify themes. Of the 48 people invited to participate, 24 completed an interview between January 28 and February 23, 2021. Five key themes were identified through inductive coding of interview transcripts: (1) teamwork and workplace camaraderie, (2) potential for growth in the field of public health, (3) considerations for adaptive work environments (eg, remote work, work out of jurisdiction, transition to telework), (4) politicization of response, and (5) constrained hiring capacity and burnout. After more than a year of public health emergency response to the COVID-19 pandemic, it is critically important to understand the detrimental and supportive factors of good mental health among the public health workforce.Item Effects of prebiotics, probiotics, and synbiotics on the infant gut microbiota and other health outcomes: A systematic review(Critical Reviews in Food Science and Nutrition, 2022-01-04) Ferro, Lynn E.; Crowley, Liana N.; Bittinger, Kyle; Friedman, Elliot S.; Decker, Jessica E.; Russel, Kathryn; Katz, Sarah; Kim, Jae Kyeom; Trabulsi, Jillian C.The primary aim of this review was to systematically evaluate the literature regarding the effect of pre-, pro-, or synbiotic supplementation in infant formula on the gastrointestinal microbiota. The Cochrane methodology for systematic reviews of randomized controlled trials (RCTs) was employed. Five databases were searched and 32 RCTs (2010–2021) were identified for inclusion: 20 prebiotic, 6 probiotic, and 6 synbiotic. The methods utilized to evaluate gastrointestinal microbiota varied across studies and included colony plating, fluorescence in situ hybridization, quantitative real-time polymerase chain reaction, or tagged sequencing of the 16S rRNA gene. Fecal Bifidobacterium levels increased with supplementation of prebiotics and synbiotics but not with probiotics alone. Probiotic and synbiotic supplementation generally increased fecal levels of the bacterial strain supplemented in the formula. Across all pre-, pro-, and synbiotic-supplemented formulas, results were inconsistent regarding fecal Clostridium levels. Fecal pH was lower with some prebiotic and synbiotic supplementation; however, no difference was seen with probiotics. Softer stools were often reported in infants supplemented with pre- and synbiotics, yet results were inconsistent for probiotic-supplemented formula. Limited evidence demonstrates that pre- and synbiotic supplementation increases fecal Bifidobacterium levels. Future studies utilizing comprehensive methodologies and additional studies in probiotics and synbiotics are warranted.Item A comprehensive evaluation of physical activity on sidewalks and streets in three U.S. Cities(Preventive Medicine Reports, 2022-01-22) Suminski, Richard R.; Dominick, Gregory M.A considerable proportion of outdoor physical activity (PA) is done on sidewalks/streets. The purpose of the current study was to create a comprehensive picture of PA and non-PA (sitting and standing) occurring on sidewalks/streets. A wearable video device was used to capture videos during 2019 in three different size (small, medium, large), U.S. cities along 24 observation routes (sidewalks/streets) located in 24 study areas that varied in walkability, income level, and minority composition. Videos were collected over the course of one year during different times of week and weekend days. Expert reviewers examined each video to extract data on counts of people engaged in different types of activities (e.g., walking) per minute of video. A total of 1154 individuals were described in 1237 min of video as either walking (66.9%), sitting/standing (25.7%), jogging (4.2%), cycling (1.8%) or skating/playing (1.4%). A greater number of active people/min were seen in the evening and in the small city (P < 0.05) while more non-PA people/min were observed in the medium city and during the weekend (P < 0.05). Active and non-PA people/min were associated with walkability, income, and minority composition. For instance, in high walkability, low income areas, 3.2 active people/min were observed in areas with a high percentage of non-minority residents compared to 0.9 active people /min in areas with a high percentage of minority residents. Sidewalks/street activities are related to dynamic interactions between social and physical environmental factors. The results of this study may serve as a reference to which future, similar evaluations can compare.Item Preliminary Effectiveness Study of a Community-Based Wellness Coaching for Cancer Survivors Program(American Journal of Lifestyle Medicine, 2022-03-01) Berzins, Nicole J.; Mackenzie, Michael; Galantino, Mary Lou; Pickles, Nicole; Hebbel, Sean; Leonard, Tara; Beneck, Diane; Peterson, MichaelPurpose: Substantial cancer burden may be prevented through lifestyle modifications. The purpose of this study was to determine the preliminary effectiveness of health coaching for the improvement of health, fitness, and overall well-being of cancer survivors in a community setting. Methods: Participants were recruited from Cancer Support Community Delaware locations. Health coaching was provided to people diagnosed with cancer anywhere along the survivorship continuum. Coaches provided 6 individual sessions. Surveys were sent pre- and post-intervention on topics including fitness, eating habits, sleep, perceived stress, anxiety, depression, and quality of life. Results were analyzed using multilevel modeling. Results: 48 participants completed an average of 85% of health coaching sessions. Coaching participants noted improvements in weekly physical activity frequency, including moderate–vigorous physical activity. Increases were found in healthy eating behavior. Participants reported improvements in the quality of their sleep, including changes in sleep duration and sleep efficiency. Significant reductions were found in perceived stress, anxiety, and depression. Importantly, participants reported improved quality of life, particularly in areas of physical and emotional well-being, as well as functional and total well-being. Conclusion: Preliminary findings indicate significant behavior change in measured outcomes and suggest health coaching may be an important tool for cancer survivorship.Item “I Think There's Only Two Fields for That”: Hospital Registrar Attitudes and Practices for Collecting Patient Gender Identity Data(Transgender Health, 2022-04-22) Mehta, Shivani; Waad, Alex; Brooks, Madeline; Siegel, Scott D.Purpose: This study aimed to understand the experiences of hospital registrars in collecting gender identity data. Methods: A qualitative study that thematically analyzed key informant interviews with 37 registrars regarding their attitudes and practices in collecting gender identity data. Results: Collection of gender identity is influenced by (1) system-level barriers, (2) discrepancies in source of truth for documentation, and (3) registrars' underlying attitudes and behaviors. Conclusions: Findings demonstrate that person- and system-level barriers can interfere with the accurate and respectful collection of gender identity data, which is critical for tracking and addressing lesbian, gay, bisexual, transgender, and queer health disparities.Item A Reflection on the Relationship Between Place and Health: Understanding Undergraduate Student Experiences and Priorities During the COVID-19 Pandemic(Delaware Journal of Public Health, 2022-08) Rao, Abhigna; Hoffman, Lindsay; Bleakley, Amy; Karpyn, AllisonEnvironment and setting have a large influence on matters of population health, and college is a critical place for students, shaping both health and education. College students across the nation were impacted by the COVID-19 pandemic, and changes at universities left many anxious, isolated, and coping with social, emotional, and educational impacts. Objective: To perform a data analysis of the qualitative responses garnered through the Student Return to Campus Survey administered at the University of Delaware (UD) in Spring 2020, and to identify common themes of student experiences and priorities during the pandemic years to inform future recommendations for health crisis management. Methods: The study utilized secondary data analysis from an online student experience survey of 2,941 Freshman, Sophomore, and Junior students from the 2020-2021 academic year. Results: Qualitative analysis revealed a set of common outstanding themes influencing the college pandemic experience, including: Quality and Accessibility of Education in a Virtual Learning Environment; Quality of Student Life; Mental Health During the Pandemic; Thoughts and Attitudes About Vaccination Policies, Masking, Testing, and COVID Guidelines; Priorities and Considerations About the Return to Campus; and Overall Feelings About the Pandemic at UD. Conclusions: Student experiences were influenced by academic, social, emotional, and financial factors, which were often described with great intensity, and were at times contradictory. Students emphasized struggles with transitioning to and with virtual learning, the quality of campus resources, financial responsibilities, family health, and personal health. The results also shed light on the importance of communication with the campus community and the desire for students to express opinions during a crisis. Health Policy Implications: The results of this study have implications for crisis management for college campuses and planning for future responses to unanticipated events and ongoing COVID-19 mitigation efforts.Item Correlates of Anxiety among Adults with Intellectual Disability: A Systematic Literature Review(Journal of Mental Health Research in Intellectual Disabilities, 2022-08-16) Powers, Brittany M.; Patterson, Freda; Freedman, Brian H.; Healy, SeanIntroduction: The aim of this systematic review was to synthe- size the literature on the correlates and risk factors of anxiety among adults with ID. Methods: Following the PRISMA guidelines, a systematic search of peer-reviewed literature was conducted across six major electronic databases. From an initial screening of 844 records, 13 studies were included for full-text review. Factors associated with anxiety were categorized utilizing the biopsychosocial model. Methodological quality was evaluated. Results: Correlates of anxiety were identified at all levels of the biopsychosocial model, including psychological or psychiatric diagnoses, level of ID, gender, chronic health conditions, stress- ful life events, and social interactions. Modifiable correlates were discussed as potential targets for designing anxiety interven- tions for adults with ID. Conclusion: Despite the increased recognition of the mental health needs of individuals with ID in recent years, this review highlighted a dearth of research investigating the risk factors of anxiety among this population.Item Concordance in caregiver and child sleep health metrics among families experiencing socioeconomic disadvantage: A pilot study(Journal of Applied Research on Children, 2022-08-25) Covington, Lauren; Satti, Aditi; Brewer, Benjamin; Blair, Rachel; Duffy, Ilona; Laurenceau, Jean-Phillipe; Mayberry, Shannon; Cordova, Angeni; Hoopes, Elissa; Patterson, FredaPurpose: Child and caregiver sleep occurs in a family system, with socioeconomically disadvantaged families experiencing disproportionately worse sleep health than more advantaged families. The extent to which objectively measured sleep health metrics (i.e., sleep duration, midpoint, regularity, efficiency) are concordant within disadvantaged family systems, including caregiver-child dyads, is not clear. To address this gap, this study aimed to: (1) characterize sleep health metrics and (2) identify levels of sleep health concordance among caregiver-child dyads living in families experiencing socioeconomic disadvantage. Design and methods: We enrolled 20 caregivers and 26 children in this micro-longitudinal study. Eligible primary caregivers slept in the same house as the child ≥4 nights/week and had no sleep disorders. Eligible children were aged 6-14 years and reported no medical problems. Dyads wore an actigraphy device continuously for 14 consecutive days. Sleep duration, bedtime, midpoint, and efficiency were estimated, and concordance evaluated using linear mixed modeling (R v.3.5.2). Results: Most caregivers were female (85%), Non-Hispanic Black (80%), and aged 40.45 years (SD=11.82). On average, caregivers were not meeting national recommendations for sleep duration and efficiency. Similarly, sleep duration recommendations were not met by child participants. Bivariate results showed that bedtime 𝑟=0.19, p<.001), sleep efficiency (𝑟=0.24, p<.001), and sleep midpoint (𝑟=0.39, p<.001), were concordant between child and caregiver. Multivariable models showed that caregiver bedtime was predictive of child sleep midpoint (b=0.16, p<.05), and caregiver sleep midpoint was predictive of child bedtime (b=0.29, p<.01) and child sleep midpoint (b=0.31, p<.001). Conclusion: Objectively estimated caregiver sleep may be connected to the sleep timing of their children. Improving child sleep may require addressing caregiver sleep habits too. Practice Implications: Results highlight the importance of providers considering caregiver sleep health when assessing child sleep health during well child visits. KEY TAKE AWAY POINTS: In this sample of caregiver-child dyads living in families experiencing socioeconomic disadvantage, on average, caregivers were not meeting national recommendations for sleep duration (7-9 hours per night) and sleep efficiency (>85%), and children were not obtaining 9-11 hours of sleep per night. Bedtime, sleep efficiency, and sleep midpoint were significantly concordant in caregivers and children, with the strongest association observed with sleep midpoint. In multivariable models, caregiver bedtime predicted child sleep midpoint, and caregiver midpoint predicted child bedtime and midpoint; highlighting the necessity of addressing poor sleep health at the family versus individual level among families experiencing socioeconomic disadvantage.Item Associations between noninvasive upper- and lower-limb vascular function assessments: extending the evidence to young women(Journal of Applied Physiology, 2022-10-01) D'Agata, Michele N.; Hoopes, Elissa K.; Witman, Melissa A.Brachial artery (BA) flow-mediated dilation (FMD) is a well-established measure of peripheral vascular function prognostic of future cardiovascular events. The vasodilatory response to FMD (FMD%) reflects upper-limb conduit artery function, whereas reactive hyperemia (RH) following cuff-occlusion release reflects upper-limb resistance artery function. Comparatively, passive leg movement (PLM) is a newer, increasingly utilized assessment of lower-limb resistance artery function. To increase its clinical utility, PLM-induced leg blood flow (LBF) responses have been compared with hemodynamic responses to FMD, but only in men. Therefore, the purpose of this study was to retrospectively compare LBF responses to FMD% and RH responses in women. We hypothesized that LBF responses would be positively associated with both FMD% and RH, but to a greater extent with RH. FMD and PLM were performed on 72 women (23 ± 4 yr). Arterial diameter and blood velocity were assessed using Doppler ultrasound. Pearson correlation coefficients were used to evaluate associations. Measures of resistance artery function were weakly positively associated: change in BA blood flow ΔBABF and ΔLBF (r = 0.33, P < 0.01), BABF area under the curve (BABF AUC) and LBF AUC (r = 0.33, P < 0.01), and BABFpeak and LBFpeak (r = 0.37, P < 0.01). However, FMD% was not associated with any index of PLM (all P > 0.30). In women, indices of resistance artery function in the upper- and lower limbs were positively associated. However, contrary to the previous work in men, upper-limb conduit artery function was not associated with lower-limb resistance artery function suggesting these assessments capture different aspects of vascular function and should not be used interchangeably in women. NEW & NOTEWORTHY: Upper- and lower-limb indices of resistance artery function are positively associated in young women when assessed by reactive hyperemia following brachial artery flow-mediated dilation (FMD) cuff-occlusion release and leg blood flow responses to passive leg movement (PLM), respectively. However, despite previous data demonstrating a positive association between upper-limb conduit artery function assessed by FMD and lower-limb resistance artery function assessed by PLM in young men, these measures do not appear to be related in young women.Item Human Milk, Infant Formula, and Other Milks Fed to Infants and Toddlers in the United States, NHANES 2007-2018(Journal of the Academy of Nutrition and Dietetics, 2022-11-01) Decker, Jessica E.; Delahanty, Michelle T.; Davey, Adam; Robson, Shannon M.; Trabulsi, Jillian C.Background For the first time, the 2020-2025 Dietary Guidelines for Americans provide specific guidance regarding the types of foods and beverages that should be offered in the first 2 years of life. Milk, in various forms (eg, human milk, infant formula, and cow’s milk) contributes a large proportion of key nutrients to the diets of infants and toddlers in the United States. Objective The aim of this study was to determine the types of milk (human milk, infant formula, and other milk) fed to US infants and toddlers in the past 12 years and to describe trends over time. Design This was a cross-sectional analysis of 2-day, 24-hour dietary recalls. Participants/setting Data from the 2007-2018 National Health and Nutrition Examination Survey were used for these analyses. Infants and toddlers aged 0 through 23.9 months with 2 days of dietary recall data (n = 3,079) were included. Main outcome measures The main outcome was proportion of infants and toddlers fed different milk types. Statistical analyses performed Survey-adjusted weighted percentages were used to report sociodemographic characteristics and the proportion of subjects fed each milk type category by age group and survey cycles. Binary and multinomial logistic regressions were used to assess differences in subject characteristics by age groups. Results Sociodemographic characteristics did not differ by age group. The proportion of infants aged 0 to <6 months fed infant formula only was 60.2% in 2007-2012 and 44.8% in 2013-2018. The proportion of infants aged 6 to <12 months fed partially hydrolyzed infant formula only was 7.3% in 2007-2012 and 13.1% in 2013-2018. In toddlers (>12 months old), cow’s milk was the predominant milk type in both 2007-2012 and 2013-2018. Conclusions The percentage of infants fed any human milk increased over the past decade. Unsweetened cow’s milk was the most predominate milk type consumed among toddlers.Item Associations between sleep and overweight/obesity in adolescents vary by race/ethnicity and socioeconomic status(Journal of Advanced Nursing, 2022-11-28) Ji, Xiaopeng; Covington, Lauren B.; Patterson, Freda; Ji, Ming; Brownlow, Janeese A.Aim To examine the interaction between sleep and social determinants of health (SDOH) [race/ethnicity and socioeconomic status (SES)] on overweight/obesity in adolescents. Design Cross-sectional. Methods We conducted a secondary analysis using the 2017–2018 National Survey of Children's Health data. We included adolescents (10–17 years old) who had sleep and body mass index (BMI) data available (n = 24,337) in analyses (samples with BMI <5th percentile excluded). Parents reported children's sleep duration and regularity. High BMI (≥85th percentile) for age defines overweight/obesity. We selected SDOH (race/ethnicity, family income, primary caregiver education and neighbourhood condition) and covariates (age, sex, smoking, exercise and depression) using a hierarchical model-building approach. Accounting for complex survey design, logistic regression estimated the interaction between sleep and SDOH. Results There were significant interactions between sleep duration and SDOH. The association between increasing sleep and decreasing odds of overweight/obesity only showed in the following subgroups: White, family income ≥400% federal poverty level (FPL) or primary caregiver' education ≥ high school. Compared with these subgroups, Hispanic adolescents and adolescents whose family income was below 100% FPL and whose caregiver education was below high school had weakened and reversed associations. Sleep regularity was not associated with overweight/obesity. Conclusions Increasing sleep duration was associated with a decreased risk of overweight/obesity, but the association was not present in adolescents from racial/ethnic minority groups (i.e. Hispanic) and those with low SES. Impact The study findings suggest that associations between sleep and overweight/obesity vary by race and SES. Identification of additional mechanisms for obesity is needed for racial/ethnic minority groups and those from families with low SES. Also, the complexity of these relationships underscores the importance of community-based needs assessment in the design of targeted and meaningful interventions to address complex health conditions such as poor sleep and obesity.Item Clinical Applications of Body Composition and Functional Status Tools for Nutritional Assessment of Hospitalized Adults: A Systematic Review(Journal of Parenteral and Enteral Nutrition, 2022-12-09) Smith, Luke O.; Olieman, Joanne F.; Berk, Kirsten A.; Ligthart-Melis, Gerdien C.; Earthman, Carrie P.Introduction: No global consensus exists on diagnostic criteria for malnutrition. Muscular deficits and functional impairments are major components of available malnutrition diagnostic frameworks (SGA, MCC, EDC, GLIM), because these facets of nutritional status significantly impact outcomes. The purpose of this review is to explore which body composition (BCA) and functional status assessment (FSA) tools are being used for nutritional assessment (NA) and monitoring response to nutritional interventions (RNI) in adult inpatients. Methods: A literature search of Embase, Medline (Ovid), Web of Science and Cochrane Central was performed to identify studies that utilized BCA and/or FSA tools for NA (along with an accepted NA diagnostic framework) and/or for monitoring RNI in adult inpatients. Results: The search yielded 3,667 articles; 94 were included in the review. The number of studies using BCA and/or FSA tools for NA was 47, and for monitoring RNI was also 47. 79% of studies used bioimpedance for BCA and 97% that included FSA utilized hand-grip strength. When compared against sets of diagnostic criteria, many of the BCA and FSA tools showed promising associations with nutritional status. Conclusions: Bioimpedance methods are the most widely used bedside BCA tools, and HGS is the most widely used FSA tool; however, these methods are being used with a variety of protocols, algorithms, and interpretation practices in heterogeneous populations. In order to create a standardized NSA process there is a need for validation studies on bedside methods and development of globally standardized assessment protocols in clinical inpatient settings.Item Antifatigue and Anti-Inflammatory Effects of Cervus elaphus L., Angelica gigas Nakai, and Astragalus membranaceus Bunge Complex Extracts in Physically Fatigued Mice(Journal of Medicinal Food, 2022-12-12) Huang, Wen Yan; Pan, Jeong Hoon; Jeong, Inhye; Oh, Seong Ju; Hyun, Yong Geon; Kim, Moon Seong; Han, Bok Kyung; Hong, Jiyoun; Koo, Yong Tae; Lee, Ki Won; Jin, Bora; Noh, Dongjin; Kim, Sangho; Kim, Jae Kyeom; Shin, Eui-Cheol; Kim, Young JunFatigue is a common complaint among people under stress, causing an array of negative effects on physical function. In this study, we investigated the antifatigue and anti-inflammatory effects of Cervus elaphus L., Angelica gigas Nakai, and Astragalus membranaceus Bunge complex extracts (CAA) using a treadmill stress test in animal models. The mice were administered various doses of CAA (50–200 mg/kg bw per day) once daily for 21 days. After exhaustive treadmill exercise, the running time of CAA-treated mice increased 1.5 times; fatigue-related biochemical parameters, including lactate dehydrogenase (∼30%), creatine kinase (∼20%), and proinflammatory cytokines interleukin (IL)-1β (∼10%), and IL-6 (∼10%) in the serum and muscle tissue were downregulated compared with those in exercised control mice. This study provides strong evidence for the prevention of CAA-induced inflammatory incidences mediated by the blockade of nuclear factor-κB activation. Collectively, our results indicate that CAA can alleviate symptoms of fatigue in mice as an effective anti-inflammatory agent.Item Snapshot of Delaware Senior Centers: COVID-19 Restrictions, Challenges and Successes(Activities, Adaptation and Aging, 2022-12-22) Orsega-Smith, Elizabeth; Beiman, Alana; Wolfle, BriannaSenior centers provide recreational and social opportunities to millions of older adults. As a result of COVID-19, many senior center directors were forced to adapt and provide new physical distancing opportunities for their members quickly. The study aimed to identify restrictions, challenges, and successes that Delaware senior center administrators faced during the COVID-19 pandemic. Interviews with 15 senior center administrators revealed that many sites relied upon state or federal guidelines for their policies while significantly reducing their specific class and activity offerings. These senior center administrators indicated a lack of guidance on openings, financial hardships, and lack of volunteers and employees as challenges they faced. Policies and frameworks should be developed to assist these organizations when adapting to future disasters.Item Diabetes Related Distress and Co-Occurrence with Depressive Symptoms in Urban Low-Income African American and Hispanic/Latinx Adults with Type 2 Diabetes(Journal of Health Disparities Research and Practice, 2023) Ruggiero, Laurie; Leng, Sarah Williams; de Groot, Mary; Gerber, Ben S.; Hernandez, Rosalba; Quinn, LaurettaIntroduction. Burden of diabetes in the U.S. is greater in racial-ethnic minority populations than non-Hispanic Whites. Depression and diabetes-related distress (DRD) are recognized as relatively common and important psychosocial areas to address in people living with diabetes. Limited research in the U.S. has focused on DRD in racial-ethnic minority populations. The purpose of this study is to describe patterns of DRD and co-occurrence with depressive symptoms in urban low-income African American and Hispanic/Latinx adults with type 2 Diabetes Mellitus (T2DM). Method. We examined the baseline data collected for a randomized clinical trial (RCT) studying the impact of a culturally tailored diabetes self-care intervention. Individuals with T2DM who self-identified as African American or Hispanic/Latinx were recruited from Federally Qualified Health Centers (FQHCs). Measurement scales included the Patient Health Questionnaire (PHQ-9) and Diabetes Distress Scale (DDS). Participants were categorized into four groups based on the PHQ-9 and DDS: high distress (without probable clinical depression), probable clinical depression (without high distress), both high distress and probable depression, or neither high distress nor probable depression. Baseline variables were summarized by sex, age and racial-ethnic group. Analyses included independent sample t-tests, Chi-square tests, and one-way Analysis of Variance (ANOVA). Results. The study sample included 247 participants with 118 (47.8%) Hispanic/Latinx and 129 (52.2%) African American adults with T2DM. The mean age was 52.9 years (SD=12.2) and 68.0% were female. Based on PHQ-9 scores, 51.4% had none to minimal, 23.5% mild, and 25.1% moderate-severe depressive symptomatology. Based on the DDS, 37.7% had little to no DRD, 27.1% moderate, and 35.2% high DRD. There was not a statistically significant relationship between sex and depression or DRD levels. There was not a statistically significant difference between age and depression; however, there was a statistically significant difference between age and DRD (p=.002). When examining the co-occurrence of DRD and depression, over half of the participants did not experience high distress nor probable clinical depression (57.5%), 17.8% experienced both high distress and depression, 17.4% experienced high distress without depression, and 7.3% experienced depression without distress. There was no statistically significant relationship found between sex and co-occurrence groups; however, there was a statistically significant difference for age (p=.003). Discussion. A substantial proportion of individuals from both racial-ethnic groups experienced high DRD and/or probable clinical depression with some differences for age. Patterns found for specific DRD areas and co-occurrence of DRD and depressive symptoms can help clinicians better understand and address these challenges.Item Examining the Professional Identity Development of Professional Master's Athletic Training Students: A Cohort Study(Athletic Training Education Journal, 2023-01-27) Gardiner-Shires, Alison M.; Kloepfer, Marlaina E.Context: Professional identity development in professional master's (PM) athletic training students occurs over time and is influenced by numerous socializing factors. Although socialization processes of athletic training students have been examined, professional identity development related to the Weidman et al graduate and professional student socialization framework [Weidman JC, Twale DJ, Stein EL, et al. Socialization of Graduate and Professional Students in Higher Education: A Perilous Passage? ASHE-ERIC higher education report. Vol 28, No. 3. Jossey-Bass Higher and Adult Education Series; 2001] has never been examined in athletic training. This model values the multiple networks, individuals, and experiences that influence graduate students throughout their program. Objective: To assess the lived experiences of 1 cohort of students enrolled in a PM athletic training program and determine what curricular and clinical education factors influence the development of professional identity. Design: Qualitative study. Setting: Focus group interview. Patients or Other Participants: Ten of 12 (83%) students (5 females and 5 males) from a single PM athletic training cohort program participated. Data Collection and Analysis: We conducted a focus group interview, which we transcribed verbatim, with participants during the last week of their last semester in the PM athletic training program. Data analysis was deductive and then inductive throughout the coding process, and we reached data saturation at the individual participant and cohort levels. We ensured trustworthiness through multiple analyst triangulation, peer expert review, and multiple data sources. Results: Three factors influenced the development of the PM athletic training student's professional identity: (1) their clinical education experiences, (2) the cohort experience, and (3) their school/life balance. Within the clinical education experience, the immersive experience, clinical setting, and patients and preceptors were also influential. Conclusions: This study used the Weidman et al socialization model. The experiences of PM athletic training students and their professional identity development are inclusive of the relationship with others throughout the educational experience, as well as their self-reflective practices within the field. It is important for stakeholders to understand the many factors that influence professional identity development.
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