Teresa J. Kelechi

Chronic leg ulcers impact millions worldwide, causing visible symptoms including discoloration, swelling, scarring, and requiring bulky bandaging, which often leads to stigma. Stigma may worsen other psychosocial impairments. This observational study examined stigma, social isolation, loneliness, anxiety, and quality of life (QOL) in adults aged 50+ receiving clinic-based wound care. Participants provided sociodemographic information and completed validated assessments. Among the 26 completers (13 with stigma/S+, 13 without stigma/S-), the average age was 63.2 years; 38% were female, and 58% Black/African American. Most (73%) had ≥high school education, 77% were single, and 42% were employed. Mean BMI was 38.7 kg/m², with 3.7 comorbidities. Stigma scores were higher in S+ (9.8 ± 4.6) versus S- group (6.0 ± 0.0). Loneliness was ≥40 for 15% (S-) versus 53% (S+). Social support was higher in S+ (77.0 ± 21.9) versus S- (64.5 ± 22.3), as was anxiety (50.5 ± 7.6 vs 43.3 ± 8.5). S+ reported lower QOL in appearance (2.8 ± 1.6) and clothing (2.4 ± 1.3). Findings underscore stigma's impact on health, warranting further research on protective and resilience interventions.

Aim: The goal of this research is to contribute to the current conversation about the experiences of African American individuals in the U.S. related to accessing and utilizing healthcare services. Introduction: National healthcare quality goals in the U.S. aim to ensure equitable access and delivery of quality care to all, yet significant disparities persist, particularly among minority and underserved populations. African Americans face higher incidence rates and poorer disease outcomes, leading to a life expectancy of 5.5 years shorter than their White counterparts. Addressing these disparities requires multilevel interventions that consider the perceptions and experiences of African American healthcare recipients, as explored in this qualitative study conducted in a southeastern U.S. region. Methods: This study utilized a qualitative descriptive design and semi-structured interviews. The recruitment utilized purposive sampling, and interviews were conducted with 7 participants between February and April of 2021. The data analysis was conducted using conventional content analysis methods. Study reporting follows the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: Three major themes emerged from the data: Clear and Open Communication, Healthcare Mistrust, and Challenges with Access to Care. The findings highlight that clear communication, healthcare mistrust, and access to care challenges are critical factors impacting the perceived quality of healthcare encounters among African Americans in a southeastern U.S. region. Conclusion: Recommendations for practice emphasize culturally competent care to address health disparities affecting African Americans. The findings highlight the importance of equitable care, more research on patient perceptions, and addressing medical mistrust through participatory research methods that include the African American community's input.

BACKGROUND: We aimed to determine whether monitoring skin temperature (Tsk) over recently healed venous leg ulcers (VLUs) can provide an objective approach to predicting reulceration. The cases presented in this article were part of a larger, multisite, 6-month randomized clinical trial of a cooling intervention to prevent ulcer recurrence among patients with chronic venous disease (CVD) and with recently healed VLUs. CASES: We report a series of four patients with CVD, three experienced VLU reulceration, and one case remained free of recurrence. Assessments of recurrence likelihood is based on daily patient Tsk self-reports using a handheld infrared (IR) thermometer and clinic visits using a combination digital and long-wave IR camera. All three cases with reulceration demonstrate a persistent 2°C above baseline average Tsk increase and a “dip-and-spike” pattern from −3°C to +5°C for several days prior to reulceration. In contrast, the patient who remained free of VLU recurrence showed a stable pattern of Tsk with minimal daily fluctuations. Thermal images showed Tsk of the affected extremity is warmer compared with the contralateral limb and increased between visits when ulcers recurred. CONCLUSION: Using IR devices to monitor Tsk among patients with CVD at risk of reulceration is an objective and reliable approach to detect changes over time. Consistent Tsk elevation over the affected area as compared to the contralateral limb and a “dip-and-spike” pattern may predict reulceration. Infrared devices showed effectiveness in detecting changes indicative of Tsk changes in recently healed leg skin over scar tissue after VLU healing. Video Abstract Video 1 Predicting venous leg ulcer re-ulceration by monitoring skin temperature {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"Predicting venous leg ulcer re-ulceration by monitoring skin temperature","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_2sei5oho"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}

Background: Mind-body interventions focused on intentional breathing and movement have been found to mitigate the negative effects of caregiving such as such as stress, psychosocial distress, and emotional distress associated for persons living with Alzheimer’s disease and related dementias. Objective: The objective was to assess the feasibility and acceptability and preliminary impacts of our 12-week mind body intervention “Gentle Yoga and Yogic Breathing” for caregivers of persons living with dementia on health outcomes including mutuality, depression and anxiety, loneliness and social support, quality of life, and physical function. Methods: We conducted a single-group cohort study in which 20 caregivers were enrolled. Data were collected at baseline and at the 12-week post-intervention endpoint. Results: The intervention was acceptable; 75% (n = 15/20) completed the study; 16 completed post-study questionnaires. Very few experienced technical issues; 31% (n = 3) most commonly reported as poor internet connectivity, 75% (n = 12/16) perceived a health benefit, 88% (n = 14/16) perceived improved day-to-day mood, and 100% (n = 16/16) would recommend the intervention to other caregivers. Although there was minimal change from baseline to 12 weeks, for health outcomes, there were very small improvements noted in anxiety and overall health. There were no reported adverse events. Conclusion: The intervention was well received and is feasible and acceptable for future studies of stress and health management interventions for caregivers of persons living with dementia. Registered with https://www.ClinicalTrials.gov (NCT03853148).

Family caregivers of adults with Alzheimer’s disease and related dementias (ADRD) are the fastest growing group of informal healthcare providers in the United States. These individuals experience high levels of stress and physical and psychosocial symptoms related to their caregiving role. We provided 20 ADRD caregivers (≥ 55 years of age) with training and access to a mobile health app for at-home practice of gentle yoga and yoga breathing exercises. Here, we report secondary outcomes, including changes in caregiver physical and mental function, burden, fatigue, sleep, and biological stress markers (salivary cortisol and 1,5-anhydroglucitol [1,5-AG] assays) from Baseline (Week 1) to Study End (Week 12). Self-reported questionnaire data were collected online via the Research Electronic Data Capture system, and biomarker data were collected via saliva samples. Results supported indications for slight improvement in outcomes of caregiving burden among ADRD caregivers using the gentle yoga and yoga breathing app. Furthermore, slight improvements in mental health were observed; the greatest gains were made by those reporting higher burden and having family members with more severe dementias. Findings indicate that those experiencing the greatest improvement in caregiver burden scores spent the most time doing gentle yoga and yoga breathing exercises. Salivary stress biomarkers moved in a favorable direction (decreased cortisol; increased 1,5-AG) among caregivers practicing the exercises most often. This is among the first studies of gentle yoga and yoga breathing exercises for relieving ADRD caregiver burden and the first we are aware of to incorporate stress biomarker measurement.

PURPOSE: This aim of this study was to evaluate the clinical efficacy of a self-managed cooling intervention in individuals with recently healed venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs) on pain reduction and physical activity improvement. DESIGN: A 6-month longitudinal randomized controlled trial. SUBJECTS AND SETTING: The sample comprised 140 individuals with previously healed VLU and DFU who received care in 3 outpatient wound centers in the Southeastern region of the United States. Participants were randomized to the MUSTCOOL or a placebo cooling patch intervention. METHODS: The cooling and placebo interventions comprised cooling or cotton-filled patch application to recently healed skin for 30 minutes, 3 times weekly plus standard of care including compression and leg elevation (participants with VLU) or therapeutic footwear and hygiene (participants with DFU) over a 6-month period. Pain severity and intensity were measured with the Brief Pain Inventory and physical activity with the International Physical Activity Questionnaire, which assessed metabolic equivalent of tasks (METs) in minutes per week. Minutes in walking time per week were assessed with an accelerometer. Data were descriptively analyzed for difference changes in scores from baseline to 6 months post-intervention. RESULTS: Data were analyzed for 81 participants randomized to cooling and placebo groups (VLUs, n = 26/29) and DFU (n = 12/16). Slight reductions in VLU pain severity (−0.5, −0.2) and interference (−0.4, −0.5) and minimal reductions in DFU pain severity (0, −0.1) and interference (0.4/0.1) were achieved. However, pain scores were low to moderate at baseline (mean 4, 0-10 with 10 worst pain possible) in both groups. For physical activity, the MET values showed low physical activity in both groups at baseline with slight improvements noted in VLU cooling and placebo groups (73/799) and DFU (1921/225), respectively. Walking time for the VLU groups improved by 1420/2523 minutes; the DFU groups improved 135/157 minutes, respectively. Findings for outcomes were not statistically significant within or between groups. CONCLUSIONS: Application of the cooling pack compared to placebo was minimally efficacious in reducing posthealing pain and improving function in this posthealed ulcer population. However for pain, scores were initially low; thus outcomes on pain, while lower, were marginal. TRIAL REGISTRATION: The study was prospectively registered with ClinicalTrials.gov on December 10, 2015 (Identifier: NCT02626156), https://clinicaltrials.gov/ct2/show/NCT02626156.

Objective: We evaluated components of an integrated, mobile health-based intervention “Activate for Life” (AFL) on health outcomes in lower-income older adults (≥ 60 years). Methods: AFL incorporates balance (Otago; OG), physical strength (Gentle Yoga and yogic Breathing; GYYB), and mental engagement (Behavioral Activation; BA) components. Thirty participants were randomly allocated to one of three study arms (n=10): OG (Arm 1), OG+GYYB (Arm 2), or OG+GYYB+BA (Arm 3; a.k.a. “full AFL”). Participants were evaluated for physical, functional, and physiological endpoints at baseline and post-intervention (12-weeks and/or 3-month follow up). Results: Improvements in pain interference and 1,5- anhydroglucitol biomarker levels over time were noted for all arms. No significant changes were observed for other physical, functional, or physiological measures. Discussion. This study illustrates potential benefits of the AFL intervention on the health of lower-income older adults. Lessons learned from this pilot trial will inform design improvements for a large-scale randomized controlled trial. Keywords: Aging; Pain; Fatigue; Intervention; Physical activity; Low income; Mobile health