Improving Folic Acid Consumption in Women at Risk for Neural Tube Defects in Florida

Two providers who participated in the Florida VitaGrant program, a site providing early childhood services to primarily Mexican Hispanic families (Site A) and a site providing home visiting services to pregnant women and families with infants (Site B), are presented as alternative models for improving folic acid levels in reproductive aged women in Florida. Site A distributed multivitamins and education in the context of health education provided to women in a group setting, once a month. Site B provided the services primarily through home visits of varying frequency. Folic acid knowledge and consumption were measured at program initiation and at a follow-up date to determine levels of improvements for both sites, by demographic characteristics. Analyses comparing age, race, and ethnicity of women served by Site A were compared to women served by Site B. These programs were then evaluated in-depth with respect to baseline and follow-up levels of folic acid knowledge and consumption of their participants. Site A seemed to be somewhat more effective at improving the knowledge and consumption patterns of its participants than Site B, although both experienced significant improvement overall. Initially, women who received services from Site A reported lower levels of baseline knowledge and multivitamin consumption than Site B clients. However, Site A clients reported higher levels of knowledge and consumption at follow up than Site B clients. The findings suggest that free multivitamin distribution and pre/interconception education can dramatically increase MVC among all participants. Program delivery that takes place in the context of a group setting may be a particularly effective way to reach women at-risk for neural tube defects

Examining clinical indications for cesarean section in a university hospital in Karachi, Pakistan

Background and objectives: Current research reports that Pakistan exceeds the recommended percent of deliveries via cesarean sections, including both emergent and non-emergent. In order to better understand the high rate of cesarean sections in Pakistan we examined the medical and non-medical indications of these surgeries at a private university hospital in Karachi. Methods: A retrospective analysis of patient medical record data was conducted from January 1st, 2018 to March 31st, 2018. The data collected was analyzed using SPSS 25. Results: The total number of deliveries during the period was n= 1,211, out of which n=602 (49.70%) were CS. The top five indications for CS were: repeat CS n=199 (44.20%), failure to progress n=58 (12.90%), abnormal lie n=42 (9.30%), fetal distress n=37 (8.20%), and fetal growth restriction n= 21 (4.70%). Conclusion: This study contributes to a broader understanding of the indications of cesarean section rates in the developing world. This information can be used to improve infant and maternal health by reducing the complications associated with operative deliveries

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. Objective: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. Methods: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. Results: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. Conclusions: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method

Food Insecurity Prevalence Across Diverse Sites During COVID-19: A Year of Comprehensive Data

Key Findings NFACT includes 18 study sites in 15 states as well as a national poll, collectively representing a sample size of more than 26,000 people. Some sites have implemented multiple survey rounds, here we report results from 22 separate surveys conducted during the year since the COVID-19 pandemic began in March 2020. 18 out of 19 surveys in 14 sites with data for before and since the pandemic began found an increase in food insecurity since the start of the COVID-19 pandemic as compared to before the pandemic. In nearly all surveys (18/19) that measured food insecurity both before and during the pandemic, more Black, Indigenous, and People of Color (BIPOC) were classified as food insecure during the pandemic as compared to before it began. Prevalence of food insecurity for BIPOC respondents was higher than the overall population in the majority of surveys (19/20) sampling a general population. In almost all surveys (21/22), the prevalence of food insecurity for households with children was higher than the overall prevalence of food insecurity. Food insecurity prevalence was higher for households experiencing a negative job impact during the pandemic (i.e. job loss, furlough, reduction in hours) in nearly all surveys and study sites (21/22). Food insecurity prevalence in most sites was significantly higher before COVID-19 than estimates from that time period. Reporting a percent change between pre and during COVID-19 prevalence may provide additional information about the rate of change in food insecurity since the start of the pandemic, which absolute prevalence of food insecurity may not capture. Results highlight consistent trends in food insecurity outcomes since the start of the COVID-19 pandemic, across diverse study sites, methodological approaches, and time

Lack of Health Maintenance and Risks in Multiple Myeloma

Health maintenance (HM) practices are essential to prevent illness, promote well- being, and maximize health. Patients with multiple myeloma (MM) are at increased risk for cardiovascular disease and cancers, yet, research on HM practices and preventative care of MM survivors has limited report. The study comprised a descriptive, correlational, and cross- sectional online survey design. Survey of patients with MM was carried out through the International Myeloma Foundation (IMF) and the Association of Cancer Online Resources (ACOR) e- mail list services. The members of the IMF and ACOR e- mail list services were surveyed, of which 237 patients responded. The modified Medical Expenditure Preventive Survey–Preventive Care questionnaire was used; it included items that ask patients regarding their healthcare practices that relate to dental care, cancer prevention, addiction, lifestyles, sensory screening, immunizations, cardiovascular, endocrine, psychosocial, and bone health. Descriptive statistics, Pearson’s chi- square, and Spearman’s rho correlation coefficient were obtained. In this study, men had statistically significant inferior global health maintenance scores than women (P = 0.002). Being employed (P = 0.054) and married or partnered (P = 0.017) were significantly correlated with better health maintenance patterns among male respondents. In contrast, no statistically significant correlations between sociodemographic factors and health maintenance patterns were found in women. Patients with MM, particularly men, require continued education and close monitoring of health maintenance practices. These findings are consistent with publications looking at gender disparities in healthcare utilization in the United States. Studies show that men, in general, are less likely to seek preventative healthcare screenings. Healthcare providers must incorporate health maintenance promotion during clinic visits

Role competency scale on shared decision-making nurses: Development and psychometric properties

Objectives: This study aimed to develop a scale that can measure the role competency of oncology nurses during shared decision-making process. Methods: A total of 226 oncology nurses who actively provide direct care to patients from inpatient and outpatient oncology units in the Midwest and Pacific Northwest completed the online or mail survey. Exploratory factor analysis and parallel analysis showed the multidimensionality of the role competency scale on shared decision-making nurses. Results: The role competency scale on shared decision-making nurses revealed four dimensions: knowledge, attitudes, communication, and adaptability. The 22 items have excellent internal consistency with a Cronbach’s alpha of 0.91. The four subscales also have adequate reliability with Cronbach’s alpha \u3e0.70 as well as greater than 0.70 Spearman–Brown’s correlation coefficients in split-half reliability testing for each subscale. Conclusion: The new scale has the potential to be used as a clinical tool to assess the need for shared decision-making education and training in oncology nurses

Barriers and Promoters to Participation in the Era of Shared Treatment Decision-Making

This study aimed to identify the barriers and promoters for participationin cancer treatment decision in the era of shared decision-making (SDM)process. A qualitative design was utilized. Nineteen nurses and 11 nursepractitioners from oncology inpatient and outpatient settings participatedin semi-structured interviews. Data were analyzed using directed contentanalysis. The findings include practice barrier, patient barrier, institutionalpolicy barrier, professional barrier, scope of practice barrier, insurancecoverage barrier, and administrative barrier. Multidisciplinary team approach,having a nursing voice during SDM, high level of knowledge of the diseaseand treatment, and personal valuation of SDM participation were perceivedas promoters. Oncology nurses and nurse practitioners face many barriersto their participation during SDM. Organizational support and system-wideculture of SDM are essential to achieve better cancer treatment decisionsoutcome. Additional studies are needed to determine the factors that canpromote more participation among nurses and nurse practitioners

Oncology Nursing and Shared Decision Making for Cancer Treatment

This study aimed to describe the contemporary role of the oncology nurse throughoutthe entire cancer shared decision-making (SDM) process. Study participants consistedof 30 nurses and nurse practitioners who are actively involved in direct careof patients with cancer in the inpatient or outpatient setting. The major themes thatemerged from the content analysis are: oncology nurses have various roles at differenttime points and settings of cancer SDM processes; patient education, advocacy, andtreatment side effects management are among the top nursing roles; oncology nursesvalue their participation in the cancer SDM process; oncology nurses believe they havea voice, but with various degrees of influence in actual treatment decisions; nurses’level of disease knowledge influences the degree of participation in cancer SDM;and the nursing role during cancer SDM can be complicated and requires flexibility