Open Access Publications

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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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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, Allison
Environment 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.
A short-term, randomized, controlled, feasibility study of the effects of different vegetables on the gut microbiota and microRNA expression in infants
(Frontiers in Microbiomes, 2024-03-01) Ferro, Lynn E.; Bittinger, Kyle; Trudo, Sabrina P.; Beane, Kaleigh E.; Polson, Shawn W.; Kim, Jae Kyeom; Trabulsi, Jillian C.
The complementary diet influences the gastrointestinal (gut) microbiota composition and, in turn, host health and, potentially, microRNA (miRNA) expression. This study aimed to assess the feasibility of altering the gut microbial communities with short-term food introduction and to determine the effects of different vegetables on the gut microbiota and miRNA expression in infants. A total of 11 infants were randomized to one of the following intervention arms: control, broccoli, or carrot. The control group maintained the milk diet only, while the other groups consumed either a broccoli puree or a carrot puree on days 1–3 along with their milk diet (human milk or infant formula). Genomic DNA and total RNA were extracted from fecal samples to determine the microbiota composition and miRNA expression. Short-term feeding of both broccoli and carrots resulted in changes in the microbiota and miRNA expression. Compared to the control, a trend toward a decrease in Shannon index was observed in the carrot group on days 2 and 4. The carrot and broccoli groups differed by weighted UniFrac. Streptococcus was increased on day 4 in the carrot group compared to the control. The expression of two miRNAs (i.e., miR-217 and miR-590-5p) trended towards decrease in both the broccoli and carrot groups compared to the control, whereas increases in eight and two different miRNAs were observed in the carrot and broccoli groups, respectively. Vegetable interventions differentially impacted the gut microbiota and miRNA expression, which may be a mechanism by which total vegetable intake and variety are associated with reduced disease risk.
Analyses of point mutation repair and allelic heterogeneity generated by CRISPR/Cas9 and single-stranded DNA oligonucleotides
(Nature Publishing Group, 9/9/16) Bialk,Pawel; Sansbury,Brett; Rivera-Torres,Natalia; Bloh,Kevin; Man,Dula; Kmiec,Eric B.; Pawel Bialk, Brett Sansbury, Natalia Rivera-Torres, Kevin Bloh, Dula Man,Eric B. Kmiec; Kmiec, Eric
The repair of a point mutation can be facilitated by combined activity of a single-stranded oligonucleotide and a CRISPR/Cas9 system. While the mechanism of action of combinatorial gene editing remains to be elucidated, the regulatory circuitry of nucleotide exchange executed by oligonucleotides alone has been largely defined. The presence of the appropriate CRISPR/Cas9 system leads to an enhancement in the frequency of gene editing directed by single-stranded DNA oligonucleotides. While CRISPR/Cas9 executes double-stranded DNA cleavage efficiently, closure of the broken chromosomes is dynamic, as varying degrees of heterogeneity of the cleavage products appear to accompany the emergence of the corrected base pair. We provide a detailed analysis of allelic variance at and surrounding the target site. In one particular case, we report sequence alteration directed by a distinct member of the same gene family. Our data suggests that single-stranded DNA molecules may influence DNA junction heterogeneity created by CRISPR/Cas9.
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 Jun
Fatigue 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.
Associations between anthropometry, body composition, and body image in athletes: a systematic review
(Frontiers in Psychology, 2024-05-13) Webb, Mary D.; Melough, Melissa M.; Earthman, Carrie P.; Katz, Sarah E.; Pacanowski, Carly R.
Introduction: Poor body image is a potent risk factor for disordered eating and eating disorders. Athletes are a population at increased risk for eating disorders despite reports of lower body image concerns compared to non-athletes. Body size and composition may influence an athlete’s susceptibility to poor body image. Methods: Five electronic databases (PubMed, Cochrane Library, PsycINFO, Web of Science, SPORTDiscus) were searched to systematically evaluate the literature regarding the association between body measures (i.e., anthropometric and body composition indicators) and body image in athletes. The systematic review was completed following PRISMA guidelines and 27 cross-sectional studies were identified for inclusion and evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Results: Studies differed in methodological assessment of anthropometry or body composition (i.e., self-reported versus researcher-measured), methods for evaluating aspects of body image, geographic location, and sport type. Higher body mass index (BMI) or percent body fat (%BF) was significantly associated with greater body dissatisfaction in 16 of 22 studies (72.7%). Positive associations between body measures and aspects of negative body image were most consistently observed among studies that assessed BMI based on self-reported heights and weights, while significant associations between body composition measures (e.g., %BF, fat mass, fat-free mass) were less common. Four of seven studies assessing relationships between BMI and an aspect of positive body image reported significant inverse relationships, while three revealed insignificant associations. Discussion: Overall, higher BMI and body fat were associated with body dissatisfaction among athletes. Future studies are needed to confirm these findings within focused populations and utilizing body composition methods (e.g., bioelectrical impedance techniques). Systematic review registration: https://www.crd.york.ac.uk/prospero/, CRD42023446518.
Associations between Brain Alpha-Tocopherol Stereoisomer Profile and Hallmarks of Brain Aging in Centenarians
(Antioxidants, 2024-08-17) Chan, Jia Pei; Tanprasertsuk, Jirayu; Johnson, Elizabeth J.; Dey, Priyankar; Bruno, Richard S.; Johnson, Mary Ann; Poon, Leonard W.; Davey, Adam; Woodard, John L.; Kuchan, Matthew J.
Brain alpha-tocopherol (αT) concentration was previously reported to be inversely associated with neurofibrillary tangle (NFT) counts in specific brain structures from centenarians. However, the contribution of natural or synthetic αT stereoisomers to this relationship is unknown. In this study, αT stereoisomers were quantified in the temporal cortex (TC) of 47 centenarians in the Georgia Centenarian Study (age: 102.2 ± 2.5 years, BMI: 22.1 ± 3.9 kg/m2) and then correlated with amyloid plaques (diffuse and neuritic plaques; DPs, NPs) and NFTs in seven brain regions. The natural stereoisomer, RRR-αT, was the primary stereoisomer in all subjects, accounting for >50% of total αT in all but five subjects. %RRR was inversely correlated with DPs in the frontal cortex (FC) (ρ = −0.35, p = 0.032) and TC (ρ = −0.34, p = 0.038). %RSS (a synthetic αT stereoisomer) was positively correlated with DPs in the TC (ρ = 0.39, p = 0.017) and with NFTs in the FC (ρ = 0.37, p = 0.024), TC (ρ = 0.42, p = 0.009), and amygdala (ρ = 0.43, p = 0.008) after controlling for covariates. Neither RRR- nor RSS-αT were associated with premortem global cognition. Even with the narrow and normal range of BMIs, BMI was correlated with %RRR-αT (ρ = 0.34, p = 0.021) and %RSS-αT (ρ = −0.45, p = 0.002). These results providing the first characterization of TC αT stereoisomer profiles in centenarians suggest that DP and NFT counts, but not premortem global cognition, are influenced by the brain accumulation of specific αT stereoisomers. Further study is needed to confirm these findings and to determine the potential role of BMI in mediating this relationship.
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.
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.
Cancer and the family: Variations by sex and race/ethnicity
(Cancer Medicine, 2024-02-01) Asiedu, Charlotte; McKinney, Nicole S.; Willis, Alliric I.; Lewis, Frances M.; Virtue, Shannon; Davey, Adam
Background Cancer affects patients and their families, but few data are available on factors associated with diversity of family structures among patients with cancer. Family is a source of both support and responsibility that must be understood to support patients and their families. Methods Pooled data (2004–2015) from the National Health Interview Study were used to compare characteristics of cancer survivors with and without minor children and differences by sex and race/ethnicity among survivors with minor children. Results 13.9% of cancer survivors have minor children in the household, and this experience is more likely for women and people who identify as other than non-Hispanic White. Conclusion There are considerable differences by sex and race/ethnicity in the characteristics of cancer survivors with minor children. Clinicians should make consideration of family circumstances a routine part of their history. Doing so will help to identify potential sources of support and responsibility that may affect adherence.
Cardiac autonomic function is preserved in young adults with major depressive disorder
(American Journal of Physiology - Heart and Circulatory Physiology, 2024-03-01) Darling, Ashley M.; Dominguez, Cynthia M.; Skow, Rachel J.; Mogle, Jacqueline; Saunders, Erika F. H.; Fadel, Paul J.; Greaney, Jody L.
The prevalence of major depressive disorder (MDD) is highest in young adults and contributes to an increased risk of developing future cardiovascular disease (CVD). However, the underlying mechanisms remain unclear. The studies examining cardiac autonomic function that have included young unmedicated adults with MDD report equivocal findings, and few have considered the potential influence of disease severity or duration. We hypothesized that heart rate variability (HRV) and cardiac baroreflex sensitivity (BRS) would be reduced in young unmedicated adults with MDD (18–30 yr old) compared with healthy nondepressed young adults (HA). We further hypothesized that greater symptom severity would be related to poorer cardiac autonomic function in young adults with MDD. Heart rate and beat-to-beat blood pressure were continuously recorded during 10 min of supine rest to assess HRV and cardiac BRS in 28 HA (17 female, 22 ± 3 yr old) and 37 adults with MDD experiencing current symptoms of mild-to-moderate severity (unmedicated; 28 female, 20 ± 3 yr old). Neither HRV [root mean square of successive differences between normal heartbeats (RMSSD): 63 ± 34 HA vs. 79 ± 36 ms MDD; P = 0.14] nor cardiac BRS (overall gain, 21 ± 10 HA vs. 23 ± 7 ms/mmHg MDD; P = 0.59) were different between groups. In young adults with MDD, there was no association between current depressive symptom severity and either HRV (RMSSD, R2 = 0.004, P = 0.73) or cardiac BRS (overall gain, R2 = 0.02, P = 0.85). Taken together, these data suggest that cardiac autonomic dysfunction may not contribute to elevated cardiovascular risk factor profiles in young unmedicated adults with MDD of mild-to-moderate severity. NEW & NOTEWORTHY This study investigated cardiac autonomic function in young unmedicated adults with major depressive disorder (MDD). The results demonstrated that both heart rate variability and cardiac baroreflex sensitivity were preserved in young unmedicated adults with MDD compared with healthy nondepressed young adults. Furthermore, in young adults with MDD, current depressive symptom severity was not associated with any indices of cardiac autonomic function.
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.
Comparing an Expanded Versus Brief Telehealth Physical Therapist Intervention for Knee Osteoarthritis: Study Protocol for the Delaware PEAK Randomized Controlled Trial
(Physical Therapy & Rehabilitation Journal, 2023-02-01) Jakiela, Jason T.; Voinier, Dana; Hinman, Rana S.; Copson, Jennifer; Schmitt, Laura A.; Leonard, Tara R.; Aily, Jéssica B; Bodt, Barry A.; White, Daniel K.
Objective The purpose of this study is to investigate whether a remotely delivered physical therapist intervention increases physical activity (PA) over 12 weeks, compared with existing web-based resources, in adults with knee osteoarthritis (OA). Methods This will be a single-center, randomized controlled trial with 2 parallel arms: (1) the Expanded Intervention (Delaware PEAK [Physical Exercise and Activity for Knee osteoarthritis]), which includes five 45- to 60-minute video conference-based sessions of supervised exercise (strengthening exercises, step goals) that are remotely delivered over 12 weeks by a physical therapist; or (2) the Brief Intervention (control group), a website that includes prerecorded videos directing participants to web-based resources for strengthening, PA, and pain management for knee OA that are freely available. The trial will enroll 100 participants who meet the National Institute for Health and Care Excellence OA clinical criteria (≥45 years old, have activity-related knee pain, and have no morning stiffness or it lasts ≤30 minutes), reside in the contiguous United States (excluding Alaska and Hawaii), and are seeking to be more physically active. Outcomes include PA (time in moderate-to-vigorous and light PA, steps per day), sedentary behaviors, treatment beliefs, and self-efficacy for exercise. Our primary outcome is moderate-to-vigorous PA. Outcomes will be measured at baseline, 12 weeks, and 24 weeks. Impact This protocol focuses on the remote delivery of physical therapy via telehealth to adults with knee OA and comes at a critical time, because the burden of inactivity is of particular concern in this population. If successful, the findings of this work will provide strong support for the broad implementation of Delaware PEAK, highlight the utility of telehealth in physical therapy, and address the critical need to utilize exercise to manage adults with knee OA through physical therapists.
Comprehensive analysis of a peripheral blood transcriptome signature in piglets infected with Salmonella Typhimurium: insight into immune responses
(Applied Biological Chemistry, 2024-08-19) Bok, Eun-Yeong; Yi, Seung-Won; Lee, Han Gyu; Kim, Jae Kyeom; Lee, Kangwook; Ha, Seungmin; Kim, Bumseok; Jung, Young-Hun; Oh, Sang-Ik
Salmonella Typhimurium (ST) infection in pigs poses a significant threat to animal health and food safety; the intricate mechanisms underlying host–immune responses and pathogen persistence remain poorly understood. To address this knowledge gap, we comprehensively analyzed the peripheral blood transcriptome in piglets infected with ST. We performed histopathological evaluation, blood parameter analysis, advanced RNA-sequencing techniques, and quantitative reverse transcription PCR (RT-qPCR)-based validation. The increasement in the monocyte counts at 2 days post-infection suggested its potential to serve as a hematological marker for ST infection in piglets. Functional and pathway enrichment analyses of the differentially expressed genes highlighted the pivotal roles of innate and adaptive immune responses, notably in pathways associated with Toll-like receptors, NIK/NF-κB signaling, cytokine signaling, and T cell proliferation. RT-qPCR-based validation using peripheral blood mononuclear cells provided additional insights into the immune system dynamics in response to ST infection, revealing the marked elevation of the interleukin (IL)-15, IL-27, and CXCL10 levels being significantly elevated in ST-infected piglets. Our comprehensive analysis underscores the multifaceted impact of ST infection on piglets and offers valuable insights into the host–pathogen interactions and the role of host immune system during ST infection.
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.
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, Freda
Purpose: 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.
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, Sean
Introduction: 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.
Demographic and service-use profiles of individuals using the CarePayment program for hospital-related medical debt: results from a nationwide survey of guarantors
(Biomed Central Ltd, 7/15/16) Lessard,Laura; Solomon,Julie; Laura Lessard and Julie Solomon; Lessard, Laura Marie
Background: Many Americans find themselves with problems paying medical bills, and medical debt can lead to numerous negative financial, social and access to healthcare outcomes. One potential market-based solution to these challenges is to provide financing options that have patient-friendly terms while complying with increasingly complex federal lending regulations. CarePayment (CP) is one entity that provides zero interest financing to individuals from participating medical facilities. An independent, initial outcome study was undertaken to understand the demographic and medical debt-related outcomes of CP users. This information is integral to understanding whether and how this program can ameliorate the negative consequences of medical debt. Methods: A nationwide telephone survey was conducted with a random sample of 8122 guarantors who were paying off CarePayment debt as of January 1, 2015. Respondents were asked about their demographic characteristics as well as self-report of negative outcomes typically associated with medical debt. Analyses included descriptive statistics along with logistic regression models comparing first-time CP users and those with higher amounts of CP debt to others. Results: The most commonly reported financial challenge related to medical bills was problems paying or being unable to pay medical bills (59.5 %). The most commonly reported access-to-care challenges were skipping a medical test or treatment recommended by a doctor (32.9 %) and having a medical problem but not going to the doctor/clinic (30.3 %). Comparisons between first-time and repeat CP users suggest that first-time users were significantly more likely to report several negative outcomes and those with both CP and non-CP debt were significantly more likely to report nearly all of the undesirable financial and access outcomes that were assessed compared to those with only CP debt. Conclusions: The results suggest that CP use, especially repeat CP use, may be associated with a reduction in many negative outcomes of medical debt. In addition, while we found that individuals with only CP debt fared better than those with both CP debt and other medical debt, 60 % of our sample had more than one source of medical debt. This suggests that the beneficial impact of CP could be increased by expanding access to the program.
Device-estimated sleep metrics do not mediate the relation between race and blood pressure dipping in young black and white women
(Journal of Clinical Hypertension, 2024-07-09) D'agata, Michele N.; Hoopes, Elissa K.; Keiser. Thomas; Patterson, Freda; Szymanski, Krista M.; Matias, Alexs A.; Brewer, Benjamin C.; Witman, Melissa A.
Short, disturbed, and irregular sleep may contribute to blunted nocturnal blood pressure (BP) dipping, a predictor of cardiovascular disease. Black women (BLW) demonstrate less BP dipping and poorer sleep health than White women (WHW). However, it remains unclear whether device-estimated sleep health metrics mediate the relation between race and BP dipping in young women. We hypothesized that the relation between race and BP dipping would be partly mediated by sleep health metrics of sleep duration, sleep efficiency, and sleep regularity. Participants (20 BLW, 17 WHW) were 18–29 years old, normotensive, nonobese, and without evidence of sleep disorders. Systolic and diastolic BP dipping were derived from 24-h ambulatory BP monitoring. Habitual sleep duration and sleep efficiency were estimated via 14 days of wrist actigraphy. Sleep duration regularity was calculated as the standard deviation (SD) of nightly sleep duration (SDSD). Sleep timing regularity metrics were calculated as the SD of sleep onset and sleep midpoint (SMSD). Mediation analysis tested the mediating effect of each sleep metric on the relation between race and BP dipping. BLW experienced less systolic (P = .02) and diastolic (P = .01) BP dipping. Sleep duration (P = .14) was not different between groups. BLW had lower sleep efficiency (P < .01) and higher SDSD (P = .02), sleep onset SD (P < .01) and SMSD (P = .01). No sleep metrics mediated the relation between race and BP dipping (all indirect effects P > .38). In conclusion, mediation pathways of sleep health metrics do not explain racial differences in nocturnal BP dipping between young BLW and WHW.
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, Lauretta
Introduction. 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.
Dietary Intakes and Supplement Use in Pre-Adolescent and Adolescent Canadian Athletes
(MDPI AG, 8/26/16) Parnell,Jill A.; Wiens,Kristin P.; Erdman,Kelly A.; Jill A. Parnell, Kristin P. Wiens and Kelly A. Erdman; Wiens, Kristin Patricia Bjerke
Young athletes experience numerous dietary challenges including growth, training/competition, unhealthy food environments, and travel. The objective was to determine nutrient intakes and supplement use in pre-adolescent and adolescent Canadian athletes. Athletes (n = 187) aged 11-18 years completed an on-line 24-h food recall and dietary supplement questionnaire. Median energy intake (interquartile range) varied from 2159 kcal/day (1717-2437) in 11-13 years old females to 2905 kcal/day (2291-3483) in 14-18 years old males. Carbohydrate and protein intakes were 8.1 (6.1-10.5); 2.4 (1.6-3.4) in males 11-13 years, 5.7 (4.5-7.9); 2.0 (1.4-2.6) in females 11-13 years, 5.3 (4.3-7.4); 2.0 (1.5-2.4) in males 14-18 y and 4.9 (4.4-6.2); 1.7 (1.3-2.0) in females 14-18 years g/kg of body weight respectively. Median vitamin D intakes were below the recommended dietary allowance (RDA) and potassium was below the adequate intake (AI) for all athlete groups. Females 14-18 years had intakes below the RDA for iron 91% (72-112), folate 89% (61-114) and calcium 84% (48-106). Multivitamin-multiminerals, vitamin C, vitamin D, vitamin-enriched water, protein powder, sport foods, fatty acids, probiotics, and plant extracts were popular supplements. Canadian pre-adolescent and adolescent athletes could improve their dietary intakes by focusing on food sources of calcium, vitamin D, potassium, iron, and folate. With the exceptions of vitamin D and carbohydrates during long exercise sessions, supplementation is generally unnecessary.

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