Katherine Hope Morgan

The MIND diet was designed as an intervention to delay neurodegeneration and has been explored by systematic reviews for associations with cognition and, more recently, cardiometabolic disease. Comparatively less is known about how the MIND diet is associated with other health outcomes (e.g., all-cause mortality, anxiety, insomnia). This scoping review included studies exploring associations between the MIND diet and health outcomes other than cognition and cardiometabolic disease. Online databases were used to identify 4090 studies published between January 2015 and April 2024, from which 47 publications were included for review. Associations between the MIND diet and health outcomes were assessed as either favorable, unfavorable, or having no statistically significant association. Overall, 47 studies were included in this scoping review, 46 were observational, and several were conducted in large, established cohort studies. Across the 47 studies, 18 different topics were explored. Higher adherence to the MIND diet was mostly associated with favorable health outcomes (65%), while roughly one-third (33%) of studies found no statistically significant associations. One study, in Italy, found that increased adherence to the MIND diet was associated with increased exposure to cadmium, a heavy metal. In populations that may benefit from the MIND diet, we recommend additional observational and exploratory studies to identify health associations. Studies exploring educational interventions would help to identify facilitators and barriers to adopting the MIND diet. This scoping review provides some evidence that higher adherence to the MIND diet is associated with risk reduction for many diseases. Further research on environmental exposures (e.g., cadmium) and other deleterious substances absorbed by food crops will be crucial as we strive to enhance health and food security through plant-rich dietary patterns.

Interprofessional collaboration (IPC) is considered the highest standard of practice for delivering care to patients with multiple, complex, and chronic conditions. Despite reported benefits of IPC, the voice of the care receiver and how or whether they experience IPC is underexplored. Our objective was to examine patients’ experiences with IPC in two rural primary care settings in the U.S., where the burden of multiple chronic conditions (MCCs) is coupled with lower life expectancies and reduced access to care. We used a semi-structured interview to assess patients’ experiences within 72 hours after an IPC healthcare visit. This study, conducted in two federally qualified health centers in rural Appalachia with a university partner, explored the narratives of 21 people with MCCs. Through inductive analysis, findings were categorized as 1) Person-Centered Care Behaviors, 2) IPC Inquiry, 3) IPC Problem-Solving, and 4) IPC Consensus on a Plan of Care. Our grounded theory proposes a model of person-centered IPC that increases patients’ confidence in the IPC plan of care. This study presents evidence that IPC offers powerful inquiry and problem-solving capacity, while placing the patient at the center of the team, practicing collaboratively, and building consensus on goals and planning. Patients enjoyed working with students, an indication that mutually beneficial opportunities exist for patients, clinicians, and trainees in settings where IPC can augment care by providing interprofessional consultations in remote and underserved areas. Our findings are consistent with person-centered care, and the benefit patients find in an IPC-created care plan.

Background: Neurodegenerative diseases (NDDs) are multifactorial disorders frequently associated with gut dysbiosis, oxidative stress, and inflammation; however, the pathophysiological mechanisms remain poorly understood. Methods: Using untargeted mass spectrometry-based metabolomics and 16S sequencing of human stool, we investigated bacterial and metabolic dyshomeostasis in the gut microbiome associated with early disease stages across three NDDs—amyotrophic lateral sclerosis (ALS), Alzheimer’s disease (AD), Parkinson’s disease (PD)—and healthy controls (HC). Results: We discovered a previously unrecognized link between a microbial-derived metabolite with an unknown role in human physiology, 2,3-dihydroxypropane-1-sulfonate (DHPS), and gut dysbiosis in NDDs. DHPS was downregulated in AD, ALS, and PD, while bacteria involved in DHPS metabolism, Eubacterium and Desulfovibrio, were increased in all disease cohorts. Additionally, select taxa within the Clostridia class had strong negative correlations to DHPS, suggesting a potential role in DHPS metabolism. A catabolic product of DHPS is hydrogen sulfide, and when in excess, it is known to promote inflammation, oxidative stress, mitochondrial damage, and gut dysbiosis, known hallmarks of NDDs. Conclusions: These findings suggest that cryptic sulfur metabolism via DHPS is a potential missing link in our current understanding of gut dysbiosis associated with NDD onset and progression. As this was a hypothesis generating study, more work is needed to elucidate the role of DHPS in gut dysbiosis and neurodegenerative diseases.

Neurodegenerative diseases (NDDs) are multifactorial disorders frequently associated with gut dysbiosis, oxidative stress, and inflammation; however, the pathophysiological mechanisms remain poorly understood. We investigated bacterial and metabolic dyshomeostasis in the gut microbiome associated with early disease stages across three NDDs, amyotrophic lateral sclerosis (ALS), Alzheimer’s Disease (AD), Parkinson’s Disease (PD), and healthy controls (HC) and discovered a previously unrecognized link between a microbial-derived metabolite with an unknown role in human physiology, 2,3-dihydroxypropane-1-sulfonate (DHPS), and NDDs. DHPS was downregulated in AD, ALS, and PD, while Eubacterium and Desulfovibrio, capable of metabolizing this metabolite, ^1–4 were increased in all disease cohorts. Additionally, select taxa within the Clostridia class had strong negative correlations to DHPS suggesting a potential role in DHPS metabolism. Hydrogen sulfide is a catabolic product of DHPS, ^1,5 and hydrogen sulfide promotes inflammation, ^6–8 oxidative stress, ⁹ mitochondrial damage, ¹⁰ and gut dysbiosis, ^2,11 known hallmarks of NDD. These findings suggest that cryptic sulfur metabolism via DHPS is a missing link in our current understanding of NDD onset and progression. To the best of our knowledge, we are the first to provide evidence of a conserved gut-brain axis linkage of specific bacterial taxa and their metabolism of DHPS shared by three neurodegenerative diseases.

Early life gut microbiota have been increasingly recognized as major contributors to short and/or long-term human health and diseases. Numerous studies have demonstrated that human gut microbial colonization begins at birth, but continues to develop a succession of taxonomic abundances for two to three years until the gut microbiota reaches adult-like diversity and proportions. Several factors, including gestational age (GA), delivery mode, birth weight, feeding types, antibiotic exposure, maternal microbiome, and diet, influence the diversity, abundance, and function of early life gut microbiota. Gut microbial life is essential for assisting with the digestion of food substances to release nutrients, exerting control over pathogens, stimulating or modulating the immune system, and influencing many systems such as the liver, brain, and endocrine system. Microbial metabolites play multiple roles in these interactions. Furthermore, studies provide evidence supporting that imbalances of the gut microbiota in early life, referred to as dysbiosis, are associated with specific childhood or adult disease outcomes, such as asthma, atopic dermatitis, diabetes, allergic diseases, obesity, cardiovascular diseases (CVD), and neurological disorders. These findings support that the human gut microbiota may play a fundamental role in the risk of acquiring diseases that may be programmed during early life. In fact, it is critical to explore the role of the human gut microbiota in early life.

Background: The human milk microbiome is an emerging scientific area. Careful, accurate collection and measurement for microbial sequencing is imperative. There is controversy about a core microbiome, and little is known about factors that influence composition. Even less known are ways that the milk microbiome might seed the infant gut and affect health. Research aim: The aim of this paper is to provide a critical appraisal of milk microbiome research. The four areas of critical appraisal were collection and measurement, composition, effects on composition, and potential health effects for infants related to the milk microbiome. Methods: Using a PRISMA-ScR scoping review, we reviewed sources of evidence extracted from PubMed, Web of Science, CINAHL, Academic Search Complete, and PSYCHINFO data sets using the following criteria: English language, published in past 6 years, primary data, and sequencing using Next Generation Sequencing. Charting of sources of evidence included authors, title, journal year, sample, design, and results. The research questions posed were: How is human milk collected and how are the microbes identified? What is the composition and what factors affect the human milk microbiome? What is the relationship of the human milk microbiome to infant biology and health? Results: The reviewed studies were quantitative, cross sectional, or longitudinal. A core microbiome may be present. The microbiome may seed the early infant gut and promote physiological functions and thus influence human health. Conclusions: We have suggested concerns about collection and measurement that lead to gaps in knowledge generation, and mechanistic studies are lacking.

Interprofessional collaboration (IPC) has been shown to improve patient safety and quality of care. Particularly, IPC assists health care providers to manage complex and chronic diseases. To this end, primary care centers around the world have begun practicing IPC; however, little is known about the patient’s experience of IPC in primary care (IPC-pc). The goals of this scoping review were to identify the studies exploring patients’ perspectives on IPC-pc and to reveal gaps in the literature for future research in order to inform policy and practice. A key word search strategy was conducted using PubMed to identify studies published from 1997 to 2017 on IPC-pc that included data collected from patients or their caregivers about patient experience or satisfaction. Seven studies met the inclusion criteria for the scoping review, and these studies were evaluated by interprofessional intervention, collaboration, and outcomes.

Many very-low-birth-weight (VLBW) infants experience growth faltering in early life despite adequate nutrition. Early growth patterns can affect later neurodevelopmental and anthropometric potentials. The role of the dysbiotic gut microbiome in VLBW infant growth is unknown. Eighty-four VLBW infants were followed for six weeks after birth with weekly stool collection. DNA was extracted from samples and the V4 region of the 16S rRNA gene was sequenced with Illumina MiSeq. A similar microbiota database from full-term infants was used for comparing gut microbiome and predicted metabolic pathways. The class Gammaproteobacteria increased or remained consistent over time in VLBW infants. Out of 228 metabolic pathways that were significantly different between term and VLBW infants, 133 pathways were significantly lower in VLBW infants. Major metabolic differences in their gut microbiome included pathways involved in decreased glycan biosynthesis and metabolism, reduced biosynthetic capacity, interrupted amino acid metabolism, changes that could result in increased infection susceptibility, and many other system deficiencies. Our study reveals poor postnatal growth in a VLBW cohort who had dysbiotic gut microbiota and differences in predicted metabolic pathways compared to term infants. The gut microbiota in VLBW infants likely plays an important role in postnatal growth.

In the current healthcare environment, the healthcare industry has become increasingly focused on population health concerns. While advanced practice registered nurses (APRNs) are well prepared to contribute to population health by delivering holistic healthcare to individuals, families, groups, communities, and populations, they are not engaged in initiatives to improve population health commensurate with their numbers, education, training, experience, and role as primary care providers and essential healthcare team leaders and members. This article discusses the rationale for integrating population health into APRN curricula, one program’s approach to doing so, and preliminary lessons learned from this effort. The three main lessons learned include population health content should be integrated across the curriculum for all APRN cohorts, supplementary population health content should be considered, and opportunities for integrating didactic population health content should be included across the FNP curriculum.