Osteoporosis: A Home Health Care Issue

Osteoporosis is a serious health issue causing premature disability to millions of Americans. Costs associated with this disease exceed 13.8 billion dollars per year. Women have a greater risk for osteoporosis than men. However, men are also susceptible to bone loss and osteoporosis. Osteoporosis education for the health care professional is warranted. Understanding risk factors and utilizing bone measurement techniques will result in earlier detection of osteoporosis. Adequate calcium intakes and weight bearing exercise is essential in prevention and maintenance of osteoporosis. This article discusses osteoporosis as a home health care issue

Screening for depression among a sample of US college students who engage in recreational prescription opioid misuse

© 2020 The Author(s). Background: Among student populations, literature has identified associations between prescription opioid misuse and symptoms of depression such as hopelessness, sadness, and emotional pain. Thus far, existing literature has yet to investigate associations between prescription opioid misuse and depression using validated screening instruments for depression when exploring such associations. The purpose of this study was to utilize a validated screening tool to explore quantifiable presence of depression among college students who engage in recreational prescription opioid misuse (RPOM). Additionally, gender differences in depression and co-occurring substance use are examined. Methods: Students (n = 104) of a large university in the Southeastern United States who reported RPOM within the past 6 months completed instrumentation assessing demographics, substance use, as well as, screening tools for depression and possible opioid use disorder (OUD). Results: Positive depression screens were significantly higher among females, however, nearly 56% of participants screened positive for major depression. Though high levels of co-occurring substance use were observed among the entire sample, males were significantly more likely to report cocaine use, more frequent use of alcohol and marijuana, as well as, exhibit a positive screen for disordered opioid use, at a rate 5 times that of their female counterparts. Conclusion: Students who engage in RPOM are a particularly heightened-risk subsample of the college population who exhibit high levels of depressive symptomatology and substance use behavior. Targeted programming and further investigations are needed among this specific population. Future studies are encouraged to utilize validated instruments when assessing depression among students

Bone mineral density among men and women aged 35 to 50 years

© 2019 American Osteopathic Association. Context: Osteoporosis is characterized by low bone mineral density (BMD) and has been thought to only be a major health concern for postmenopausal women. However, osteoporosis and its risk factors have been greatly understudied in the middle-aged and male populations. Objective: To assess the likelihood of low BMD and its association with related risk factors in early–middle-aged (defined in this study as 35-50 years) men and women.Methods: Eligible men and women completed a questionnaire assessing calcium intake, hours per week of exercise, and other related risk factors associated with osteoporosis and osteopenia. The primary outcome variable, BMD, was attained using dual-energy x-ray absorptiometry scans taken at the femoral neck, trochanter, intertrochanteric crest, total femur, and lumbar spine.Results: Of the 173 participants in this study, 23 men (28%) and 24 women (26%) had osteopenia at the femoral neck. In men, there was a significant and negative correlation between exercise and femoral neck BMD (r=−0.296, P=.01). In women, correlation analyses showed significant positive correlations between exercise and BMD of the trochanter (r=0.329, P=.003), intertrochanteric crest (r=0.285, P=.01), total femur (r=0.30, P=.01), and lumbar spine (r=0.29, P=.01).Conclusions: Osteopenia was found in more than 25% of both male and female participants, which suggests that more osteoporosis screening and prevention programs need to be targeted to persons in the studied age group because osteopenia can lead to osteoporosis

Factors Influencing Sun Protection Behaviors among Patients with Skin Cancer: An Application of the Information-Motivation-Behavioral Skills Model

© 2019 by the Dermatology Nurses\u27 Association. This study aimed to assess predictors of sun protection behaviors based on the information-motivation-behavioral skills (IMB) model among people diagnosed with nonmelanoma skin cancer (NMSC). For this descriptive, cross-sectional study, a convenience sample of 311 patients with NMSC was recruited at a medical center in Mississippi. Patients were invited to complete a face- A nd content-valid, IMB-model-based questionnaire. The average age of the participants was 64.12 (±12.02) years, and most (58.8%) were male. Most participants indicated not using sun protection behaviors while outdoors. Findings showed that sun protection behaviors were directly predicted by self-efficacy (standardized path coefficient = 0.504, p \u3c.001) and social support (standardized path coefficient = 0.199, p =.010). In addition, sun protection behavior was indirectly predicted (through self-efficacy) by social support (standardized indirect effect = 0.160, p \u3c.001) and attitudes (standardized indirect effect = 0.192, p =.001). The explained variances for self-efficacy and sun protection behaviors were 43% and 35.4%, respectively. In conclusion, the IMB model appears to be a useful theoretical framework for predicting sun protection behaviors among patients with NMSC. Sun safety intervention programs should be developed based on this theoretical model for patients with NMSC

Osteoporosis knowledge and health beliefs among middle-aged men and women in the Southern United States

Context: The most common skeletal disease, osteoporosis, causes bone fragility due to decreased bone mass and bone microarchitecture destruction. The health belief model is often applied to asymptomatic, prevention-related diseases such as osteoporosis. Steps to mitigate the insidious nature of osteoporosis, including education, motivation, and monitoring of bone mineral density, must begin at an earlier age. Objectives: This study evaluates the knowledge and health beliefs surrounding osteoporosis in a population of males and females 35–50 years old to determine sex-based differences in osteoporosis knowledge and beliefs and to assess the correlation between perceptions and health motivation. Methods: Participants (81 males, 92 females) completed two questionnaires: the Osteoporosis Knowledge Test and the Osteoporosis Health Belief Scale. Descriptive statistics were performed along with Pearson product-moment correlation analysis to determine the relationships between the variables. Sex-based differences were calculated utilizing independent t-tests. Results: We discovered a statistically significant negative correlation between the barriers to exercise and health motivation (-0.434, p \u3c 0.001) and a statistically significant positive correlation between the benefits of exercise and health motivation (0.385, p \u3c 0.001). However, there was not a statistically significant correlation between health motivation with the following: the benefits of calcium, susceptibility, and the seriousness of osteoporosis. Between males and females, there was a statistically significant difference in exercise and calcium knowledge, susceptibility, and the benefits of both exercise and calcium (p \u3c 0.05). Conclusions: Males and females 35–50 years old perceive themselves to have a low susceptibility to osteoporosis. They do not consider osteoporosis a serious disease and have little motivation to mitigate its inception or progression. Their perceptions show that barriers to exercise impact health motivation more than the perceived benefits of exercise

Skin Cancer Knowledge, Attitudes, and Behaviors in Collegiate Athletes

Outdoor athletes represent an important group at risk for skin cancer because they are routinely exposed to high levels of ultraviolet radiation. The purpose of this study was to assess current skin cancer knowledge, attitudes, and behaviors among collegiate athletes. A modified version of the Melanoma Risk Behavior Survey was completed by 343 athletes attending a Southern University in the USA, generating an 87% response rate. Survey results demonstrated that the majority of the athletes do not limit their sun exposure and reported low levels of sun protective behaviors. In addition, athletes lacked knowledge about skin cancer and sun protection. Eighty-three percent of the athletes stated that tanning beds improve one's overall health. Race was significantly associated with skin cancer knowledge, whereas, gender was found to be significantly associated with knowledge, attitudes, and behaviors towards skin cancer. Additionally, there was a significant relationship between knowledge and behavior, but not between attitude and behavior. This study highlights the need to educate athletes about the hazards of tanning to minimize UV exposure and promote sun protection habits. Moreover, athletes should be educated on the dangers of indoor tanning facilities and encouraged to avoid these facilities

Skin Cancer Knowledge, Beliefs, Self-Efficacy, and Preventative Behaviors among North Mississippi Landscapers

There are slightly over one million workers in the landscape service industry in the US. These workers have potential for high levels of solar ultraviolet radiation exposure, increasing their risk of skin cancer. A cross-sectional sample of 109 landscapers completed a self-administered questionnaire based on Health Belief Model (HBM). The participants correctly answered 67.1% of the knowledge questions, 69.7% believed they were more likely than the average person to get skin cancer, and 87.2% perceived skin cancer as a severe disease. Participants believed that the use of wide-brimmed hats, long sleeved shirts/long pants, and sunscreen was beneficial but reported low usage of these and other sun protective strategies. The primary barriers to using sun protection were “I forget to wear it” and “it is too hot to wear.” Of the HBM variables, perceived benefits outweighing perceived barrier (, ) and self-efficacy (, ) were correlated with sun protection behaviors. The reasons for absence of the relationship between perceived skin cancer threat and sun protection behaviors could be lack of skin cancer knowledge and low rate of personal skin cancer history

Revisions to the Classification, Nomenclature, and Diversity of Eukaryotes

This revision of the classification of eukaryotes follows that of Adl et al., 2012 [J. Euk. Microbiol. 59(5)] and retains an emphasis on protists. Changes since have improved the resolution of many nodes in phylogenetic analyses. For some clades even families are being clearly resolved. As we had predicted, environmental sampling in the intervening years has massively increased the genetic information at hand. Consequently, we have discovered novel clades, exciting new genera, and uncovered a massive species level diversity beyond the morphological species descriptions. Several clades known from environmental samples only have found their home. Sampling soils, deeper marine waters, and the deep sea will continue to fill us with surprises. The main changes in this revision are the confirmation that eukaryotes form at least two domains, the loss of monophyly in the Exavata, robust support for the Haptista and Cryptista. We provide suggested primer sets for DNA sequences from environmental samples that are effective for each clade. We have provided a guide to trophic functional guilds in an appendix, to facilitate the interpretation of environmental samples. This revision of the classification of eukaryotes updates that of the International Society of Protistologists (Adl et al., 2012). Since then, there has been a massive increase in DNA sequence information of phylogenetic relevance from environmental samples. We now have a much better sense of the undescribed biodiversity in our environment (Pawlowski et al., 2012; de Vargas et al., 2015). While significant, it still remains a partial estimation as several continents and soils in general are poorly sampled, and the deeper ocean is hard to reach. This new data clarified phylogenetic relationships and the new information is incorporated in this revision

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570