Bertha E. Flores

Military-civilian reintegration represents a multidimensional transition, with 47 to 75% of Veterans reporting reintegration challenges. Emerging research suggests that challenges related to purpose in life, social connection, and financial stability are associated with suicide risk and broader well-being outcomes among Veterans. Guided by a normative transitions theory framework integrating psychosocial challenges (M-CARM) and enrichment (ELS), this cross-sectional study examined reintegration among 410 post-9/11 Veterans. Secure housing loss and unmet mental health needs were associated with multiple reintegration outcomes including Genuine Relationships, Sense of Purpose, Resentment and Regret, and Mental Health. A higher VA disability rating was associated with lower Physical Health and Engaged Citizenship. Unmet mental health needs were inversely associated with seven of nine reintegration outcomes. These findings underscore the value of multidimensional assessment and highlight the importance of housing stability, mental health needs, and broader reintegration challenges. Longitudinal research is needed to clarify how psychosocial challenge and enrichment interact over time and how challenges and enrichment may inform reintegration support and suicide prevention efforts.

Musculoskeletal symptoms (MSS) and sleep problems are prevalent in nurses. Evidence exploring associations between sleep and MSS in nurses is limited by self-reported sleep measures and recalling MSS over a long period. The purpose of this study was to examine the relationship between MSS and sleep in nurses using objective sleep measures and real-time MSS assessment. This 7-day observational study included 31 nurses who work day shifts. Sleep duration and efficiency were measured using accelerometers, and MSS were reported using ecological momentary assessment. Sleep metrics and MSS were compared between workdays and days off, and a regression model analyzed the effect of sleep duration on MSS while controlling for age and body mass index (BMI). On average, nurses did not sleep the minimum recommended duration of 7 h (6.28, SD = 1.31), and they slept significantly less prior to a workday (5.98 h, SD = 1.12) than a day off work (6.69 h, SD = 1.43) (t(185) = −5.92, p < 0.0001). Short sleep duration was associated with 18% higher MSS when controlling for age and BMI (t(822) = 2.63, p = 0.009). Understanding the association between sleep and MSS is important to healthcare organizations and policy makers because sleep is essential for health and recovery, and occupational characteristics, such as shift length and consecutive shifts, influence sleep. Nurse fatigue is detrimental to patient safety and the health of the nursing workforce, and musculoskeletal problems contribute to nurse attrition. This study may inform future research on organizational policies related to nurse fatigue and musculoskeletal symptoms.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The high prevalence of type 2 diabetes (T2D) and associated complications disproportionately affect low-income Latino populations, who also experience disparities in diabetes self-management (DSM), including poor medication adherence, physical activity, diet, and glycemic control. Objective: This study examined, through an academic-community partnership, the effectiveness of ¡Salud, Salud! (an evidence-based, family-centered diabetes self-management education and support [DSMES] program) on primary (glycemic control and quality of life) and secondary (social, psychological, and behavioral factors related to T2D management) outcomes among low-income Latino adults with T2D or prediabetes. Methods: In total, 81 adults (mean age 48.90 years, SD 12.57; n=57, 70.4%, female; n=66, 81.5%, Latino) with T2D or prediabetes were enrolled in a 12-week, single-arm quasi-experimental study conducted in two Central Texas Young Men’s Christian Association (YMCA) locations. ¡Salud, Salud! incorporated individual coaching by community health workers (CHWs), online family-centered DSMES training lessons, and a YMCA family membership. The delivery of ¡Salud, Salud! was supported and facilitated by digital technologies, including a dashboard to deliver intervention content and monitor participants’ engagement in intervention activities. Outcomes measured at baseline and 12 weeks (ie, postintervention) included hemoglobin A1c (HbA1c); quality of life; anthropometrics; self-reported physical activity and diet; mindfulness; perceived stress; and diabetes-related knowledge, self-efficacy, and support. Participant engagement in program activities was assessed via four index variables that underlay multiple dimensions of influences on ¡Salud, Salud! uptake: family engagement and support, participation in self-management education, program support and facilitation, and participation in self-monitoring. Paired t-tests and McNemar chi-square tests were used to examine the change in outcomes from baseline to 12 weeks. The number of program activities participants completed for each engagement index variable was converted to percentages to estimate the mean proportion of activities completed. Results: In total, 48 (59.3%) participants completed the 12-week posttest. At the end of the program, participants demonstrated a marginally significant reduction in HbA1c (–0.30%, P≤.09) and a significant increase in participants reporting good-to-excellent health from baseline (n=19, 39.6%) to posttest (n=28, 58.3%; P≤.003). There were significant reductions in body weight (–1.30 kg, P=.02), body fat percentage (–1.26%, P=.01), perceived stress (–0.28, P=.02), added sugar intake (–2.15 teaspoons/day, P=.001), and time spent sedentary per week (–70.27 minutes, P=.003) from baseline to posttest. Mindfulness increased significantly (2.21, P=.01). Participant engagement in ¡Salud, Salud! varied, with participants exhibiting a high completion rate in program support and facilitation activities (88%) and a moderate-to-low completion rate in self-management training (66%), self-monitoring (56%), and family engagement and support (49%) activities. Conclusions: ¡Salud, Salud! shows promising preliminary effects on key diabetes-related outcomes. Future research should investigate how to enhance participant engagement and optimize uptake of evidence-based T2D self-management practices among low-income Latino adults with diabetes.

BACKGROUND The high prevalence of type 2 diabetes (T2D) and associated complications disproportionately affect low-income Latino populations, who also experience disparities in diabetes self-management (DSM), including poor medication adherence, physical activity, diet, and glycemic control. OBJECTIVE This study examined, through an academic-community partnership, the effectiveness of ¡Salud, Salud! (an evidence-based, family-centered diabetes self-management education and support [DSMES] program) on primary (glycemic control and quality of life) and secondary (social, psychological, and behavioral factors related to T2D management) outcomes among low-income Latino adults with T2D or prediabetes. METHODS In total, 81 adults (mean age 48.90 years, SD 12.57; n=57, 70.4%, female; n=66, 81.5%, Latino) with T2D or prediabetes were enrolled in a 12-week, single-arm quasi-experimental study conducted in two Central Texas Young Men’s Christian Association (YMCA) locations. ¡Salud, Salud! incorporated individual coaching by community health workers (CHWs), online family-centered DSMES training lessons, and a YMCA family membership. The delivery of ¡Salud, Salud! was supported and facilitated by digital technologies, including a dashboard to deliver intervention content and monitor participants’ engagement in intervention activities. Outcomes measured at baseline and 12 weeks (ie, postintervention) included hemoglobin A1c (HbA1c); quality of life; anthropometrics; self-reported physical activity and diet; mindfulness; perceived stress; and diabetes-related knowledge, self-efficacy, and support. Participant engagement in program activities was assessed via four index variables that underlay multiple dimensions of influences on ¡Salud, Salud! uptake: family engagement and support, participation in self-management education, program support and facilitation, and participation in self-monitoring. Paired t-tests and McNemar chi-square tests were used to examine the change in outcomes from baseline to 12 weeks. The number of program activities participants completed for each engagement index variable was converted to percentages to estimate the mean proportion of activities completed. RESULTS In total, 48 (59.3%) participants completed the 12-week posttest. At the end of the program, participants demonstrated a marginally significant reduction in HbA1c (–0.30%, P≤.09) and a significant increase in participants reporting good-to-excellent health from baseline (n=19, 39.6%) to posttest (n=28, 58.3%; P≤.003). There were significant reductions in body weight (–1.30 kg, P=.02), body fat percentage (–1.26%, P=.01), perceived stress (–0.28, P=.02), added sugar intake (–2.15 teaspoons/day, P=.001), and time spent sedentary per week (–70.27 minutes, P=.003) from baseline to posttest. Mindfulness increased significantly (2.21, P=.01). Participant engagement in ¡Salud, Salud! varied, with participants exhibiting a high completion rate in program support and facilitation activities (88%) and a moderate-to-low completion rate in self-management training (66%), self-monitoring (56%), and family engagement and support (49%) activities. CONCLUSIONS ¡Salud, Salud! shows promising preliminary effects on key diabetes-related outcomes. Future research should investigate how to enhance participant engagement and optimize uptake of evidence-based T2D self-management practices among low-income Latino adults with diabetes. CLINICALTRIAL

Background: Musculoskeletal problems contribute to nurse attrition, which compromises patient safety and costs healthcare organizations millions of dollars. Recent research describes a physical activity paradox in which high amounts of work-related physical activity may be detrimental to health; however, there is a lack of evidence on the physical activity paradox with respect to musculoskeletal health in nurses. The purpose of this study was to examine the relationship between musculoskeletal symptoms (MSSs) and high amounts of physical activity at work in nurses. Methods: This was a 7-day observational design using direct measurement of physical activity and self-reported MSSs in nurses. Physical activity was measured in step counts using a wearable accelerometer and MSSs were reported using ecological momentary assessment. Step counts and MSSs were compared between work days and days off, and a regression model analyzed the combined effect of physical activity and work days on MSSs while controlling for age, exercise, and body mass index. Results: Musculoskeletal symptoms and step counts were significantly higher on work days compared to days off. Higher step counts on work days resulted in significantly higher expected MSS ratings than the same number of steps taken on a day off. Conclusions: This study supports the existence of a physical activity paradox in nurses with respect to MSSs. Understanding this paradox in the nursing workforce can translate to interventions that reduce the detrimental health effects of high levels of physical activity at work, which can minimize nurse attrition, improve patient outcomes, and reduce costs in healthcare organizations.

Despite efforts to dissuade major manufacturers and retailers from marketing and selling vape products to adolescents, the practice of vaping continues to increase in this population. Few studies have assessed adolescent perceptions of vaping, access to vaping, and use of vaping, and most rely, at least in part, on inferential conclusions drawn from data on smoking traditional combustible cigarettes. A novel electronic survey was created to assess the use of vapes, perceptions of vaping, and access to vaping among a convenience sample of adolescents (ages 12–20 years) in eleven schools in South-Central Texas from May to August 2021. The students’ perceived threat of negative health outcomes due to vaping was calculated based on questions soliciting perceptions of severity (perceived danger) and susceptibility (perceived likelihood of illness). Trends were identified using descriptive and bivariate statistical tests. A total of 267 respondents were included; 26% had tried vaping. A majority (63%) did not believe vaping and smoking were synonymous. Most (70%) thought it was easy to obtain supplies and (76%) vape before and after (88%) or even during (64%) school. Respondents who vaped had a 34% lower perceived threat when compared to respondents who did not vape. In this sample of adolescents from South-Central Texas, one in four reported that they had tried vaping. Easy access to vapes and misperceptions regarding the safety of vaping might create a false sense of security with respect to vaping as an alternative to smoking, particularly among those who reported vaping, and is likely contributing to the increased use of vapes.

Completion of human papillomavirus (HPV) vaccine series among Texas Hispanic adolescents is low compared to national data. We examined the association between HPV vaccine initiation and completion among Hispanic adolescents in a rural, Texas-Mexico border county and specific individual and neighborhood-level characteristics. Cross-sectional analysis of data from a broader cancer prevention program. Underserved colonias communities in a Texas-Mexico border county. Hispanic mothers or caregivers (n=712) and adolescents aged 11-17 years (n=1120) linked to publicly available data about their neighborhood. HPV vaccine adherence (ie, initiation and completion) as reported in either the Texas Immunization Registry or adolescents’ electronic medical records, measured at the end of the cancer prevention program. Logit and multi-level mixed-effects logistic regression of individual- and neighborhood-level data. Factors associated with HPV vaccine initiation and completion were female gender (P<.01), adolescent insurance status (P<.001), and receipt of required vaccines (P<.001). After controlling for neighborhood-level characteristics, only receipt of required vaccines remained significant Findings indicate a relationship between Hispanic adolescents’ receiving the required vaccine series for school admission and HPV vaccine initiation and completion. In resource-limited settings like federally qualified health centers, further efforts should focus on implementing best practices at both the provider level (eg, education on bundled vaccine recommendation) and practice-level (eg, outreach and support by trained immunization navigators).

Hispanic family caregivers of people with dementia experience higher levels of stress compared to non‐Hispanic white caregivers. Long‐term stress causes depression, caregiver burden, cellular aging, and dysregulation of the immune, nervous, and endocrine systems. The purpose of this study was to determine the validity of the Spanish version of the English Stress‐Busting Program (SBP) for Family Caregivers by determining changes in quality‐of‐life measures and biomarkers. Thirty‐six caregivers completed the SBP in the language of their choice (14 Spanish‐speaking Hispanics [HS], 8 English‐speaking Hispanics [HE], and 14 non‐Hispanic English [NHE] speakers). Quality‐of‐life measures included the Perceived Stress Scale, the Screen for Caregiver Burden, and the Center for Epidemiologic Studies Depression Scale. Assessment of oral health and immunity included salivary flow rate, pH, buffer capacity, total protein, and secretory immunoglobulin A (sIgA). Indicators of stress (salivary cortisol), inflammation (C‐reactive protein), and cellular aging (leukocyte telomere length) were assessed. Following completion of the SBP, the Spanish‐speaking group had less depression and caregiver burden along with improved oral health and reduced cellular aging. When comparing baseline values to post‐intervention, all three groups showed significant improvement in subjective caregiver burden. When the data from all three groups were combined, biomarkers that showed improvement after nine weeks of SBP included the stress hormone cortisol, salivary pH, and leukocyte telomere length. The results indicate that the Spanish SBP reduces caregiver stress as assessed by quality‐of‐life indicators and biomarkers. The Spanish SBP can help to mitigate health disparities in Hispanic Spanish‐speaking caregivers.

Background: Cancer is a taxing chronic disease that demands substantial care, most of which is shouldered by informal caregivers. As a result, cancer caregivers often have to manage considerable challenges that could result in severe physical and psychological health consequences. Technology-based interventions have the potential to address many, if not all, of the obstacles caregivers encounter while caring for patients with cancer. However, although the application of technology-based interventions is on the rise, the term is seldom defined in research or practice. Considering that the lack of conceptual clarity of the term could compromise the effectiveness of technology-based interventions for cancer caregivers, timely research is needed to bridge this gap. Objective: This study aims to clarify the meaning of technology-based interventions in the context of cancer caregiving and provide a definition that can be used by cancer caregivers, patients, clinicians, and researchers to facilitate evidence-based research and practice. Methods: The 8-step concept analysis method by Walker and Avant was used to analyze the concept of technology-based interventions in the context of cancer caregiving. PubMed, PsycINFO, CINAHL, and Scopus were searched for studies that examined technology-based interventions for cancer caregivers. Results: The defining attributes of technology-based interventions were recognized as being accessible, affordable, convenient, and user-friendly. On the basis of insights gained on the defining attributes, antecedents to, and consequences of technology-based interventions through the concept analysis process, technology-based interventions were defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. Conclusions: This study clarified the meaning of technology-based interventions in the context of cancer caregiving and provided a clear definition that can be used by caregivers, patients, clinicians, and researchers to facilitate evidence-based oncology practice. A clear conceptualization of technology-based interventions lays foundations for better intervention design and research outcomes, which in turn have the potential to help health care professionals address the needs and preferences of cancer caregivers more cost-effectively.

Background: Cancer patients are particularly vulnerable to COVID-19, partially owing to their compromised immune systems and curbed or cut cancer healthcare services caused by the pandemic. As a result, cancer caregivers may have to shoulder triple crises: the COVID-19 pandemic, pronounced healthcare needs from the patient, and elevated need for care from within. While technology-based health interventions have the potential to address unique challenges cancer caregivers face amid COVID-19, limited insights are available. Thus, to bridge this gap, we aim to identify technology-based interventions designed for cancer caregivers and report the characteristics and effects of these interventions concerning cancer caregivers' distinctive challenges amid COVID-19.Methods: A systematic search of the literature will be conducted in PubMed, PsycINFO, CINAHL, and Scopus from the database inception to the end of March 2021. Articles that center on technology-based interventions for cancer caregivers will be included in the review. The search strategy will be developed in consultation with an academic librarian who is experienced in systematic review studies. Titles, abstracts, and full-text articles will be screened against eligibility criteria developed a priori. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process.Conclusions: COVID-19 has upended cancer care as we know it. Findings of this study can shed light on evidence-based and practical solutions cancer caregivers can utilize to mitigate the unique challenges they face amid COVID-19. Furthermore, results of this study will also offer valuable insights for researchers who aim to develop interventions for cancer caregivers in the context of COVID-19. In addition, we also expect to be able to identify areas for improvement that need to be addressed in order for health experts to more adequately help cancer caregivers weather the storm of global health crises like COVID-19 and beyond.Systematic review registration: PROSPEROCRD42020196301