Jeanne A. Teresi

Background: Resident‐to‐resident aggression (RRA) in long‐term care settings is widespread with the potential for serious detrimental outcomes. However, few evidence‐based training, intervention, and implementation strategies exist. The objective was to evaluate intervention process outcomes (knowledge), and proximal and distal outcomes (increased recognition, documentation, and reporting) in assisted living facilities. Methods: Staff reported on RRA with respect to 930 residents (495 intervention and 435 usual care) from 14 New York assisted living facilities (7 per group). Data were collected at baseline, 6 and 12 months. Intervention site staff received training, while usual care staff did not. Knowledge outcomes were measured using two 10‐item scales. Recognition and documentation for care planning were measured on an ongoing basis in real time, and longitudinal reporting of past two‐week events through a structured interview. Mixed models were used to evaluate continuous knowledge variables. Outcome evaluation was conducted on an intent‐to‐treat basis using Poisson regressions for longitudinal count data measuring recognition/documentation and reporting. Results: A total of 238, 263, and 217 staff attended Modules 1–3, respectively. There was a statistically significant increase in knowledge post‐training, controlling for pre‐training levels (estimated mean = 1.37, 95% CI, 1.11–1.62, p < 0.001 for Module 1 and estimated mean = 0.46, 95% CI, 0.21–0.70, p < 0.001 for Module 2). The program statistically significantly increased recognition and documentation of RRA in real time (estimated log mean = 4.34, 95% CI, 1.22–7.45, p = 0.006); there were 92 incidents reported by intervention group staff as contrasted with one in the usual care group. In terms of longitudinal reporting of events using a structured interview, a significant between‐group difference was observed (estimate = 0.64, 95% CI, 0.18–1.09, p = 0.006). Conclusions: The training intervention was demonstrated as effective in enhancing knowledge, recognition/documentation, and reporting of RRA in assisted living, replicating findings in nursing homes. It is recommended that this program be disseminated in long‐term care facilities. Trial Registration: Clinical Trials.gov identifier: NCT03383289 registered December 26, 2017. The first subject was enrolled May 26, 2018; the last subject was enrolled August 2022; follow‐up data collection was completed June 5, 2023.

Objective: To determine if prenatal socioeconomic status (SES) is associated with childhood working memory (WM), we constructed a more precise, integrative measure of WM using variables from multiple tasks that may provide a more representative measure of WM. Study Design: We used data from a prospective birth cohort study in Mexico City, Mexico, with N = 515 children aged 6–9 years. Prenatal SES was measured using the Mexican Association of Marketing Research and Public Opinion Agencies (AMAI) index. We created a latent variable for nonverbal working memory using multiple tasks (Cambridge Neuropsychological Test Automated Battery spatial working memory, operant chamber Delayed Match to Sample and Incremental Repeated Acquisition). Structural equation models were used to assess associations between prenatal SES and nonverbal working memory, adjusting for child demographics (e.g., age and sex), prenatal exposures (e.g., exposures to lead, arsenic, and secondhand smoke), and family (current SES, maternal IQ) variables. Results: Children had a mean age of 6.6 years [SD 0.6], and 50.5% were boys. Using confirmatory factor analysis, we constructed a latent variable of nonverbal working memory, which was measurement invariant across child sex. Prenatal SES was associated with childhood nonverbal working memory (standardized factor loading = 0.17; p = 0.004). These associations were modified by child sex. Higher prenatal SES was significantly associated with higher childhood WM in females (standardized factor loading = 0.26; p = 0.002), but not in males. Conclusions: Prenatal socioeconomic status is a predictor of childhood working memory, but it may be a stronger predictor for girls compared with for boys.

Background: Colorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polyps removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk. Design and methods: We aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-month follow-up, and Life Simple7 (LS7)—a cardiovascular disease (CVD) risk score—at 6 months and 1 year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed-methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. Discussion: Church-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction. Trial registration: NCT05174286; clinicaltrials.gov; August 31^st, 2023

Background and Purpose: The Medication Management Test (MMT) measures higher cognitive functioning. The aim of the analyses presented was to reduce assessment burden by developing a short-form version, and describe its psychometric properties. Methods: Factor analyses, item response theory (IRT), and differential item functioning (DIF) were performed to examine the dimensionality, reliability information, and measurement equivalence. Results: The ratio of the first two extracted eigenvalues from the exploratory principal component analysis was 7.62, indicating essential unidimensionality. Although one item “needs prompting for pill regime” evidenced DIF above the threshold for education and race/ethnicity, the magnitude was relatively small and the impact minimal. IRT-based reliability estimates were high (>0.80) across all subgroups. Conclusions: Because medication management is an important task associated with independent living, it is critical to assess whether medications can be self-administered safely.