Chitchanok Benjasirisan

Background: Asian adults in the U.S. face increased burdens of cardiovascular risk factors and cardiovascular disease (CVD). However, trends in cardiovascular health among Asian subgroups remain understudied. Objectives: The purpose of this study was to examine 15-year trends in CVD risk factors and CVD among Chinese, Filipino, and Asian Indian adults living in the U.S. Methods: We conducted a retrospective secondary analysis using data from the 2004–2018 National Health Interview Survey. Age-standardized prevalence rates were calculated for eight variables: hypertension, type 2 diabetes, overweight/obesity, short sleep, alcohol use, smoking, insufficient physical activity (PA), and CVD (defined as having coronary heart disease, heart attack, stroke, or other cardiovascular conditions). Annual percent change and average annual percent change were employed to summarize and compare the trends of each variable over 15 years. Results: The sample consisted of 14,073 adults, with the majority aged 65 years or older and half being female. Filipino adults showed the highest prevalence for most variables, except for diabetes and insufficient PA, compared to Chinese and Asian Indian adults. From 2004 to 2018, Asian adults overall experienced increases in the prevalence of diabetes, overweight/obesity, and alcohol use, and decreases in the prevalence of smoking and insufficient PA. Specifically, Chinese adults exhibited significant upward trends in short sleep. Asian Indian adults exhibited upward trends in overweight/obesity and alcohol use, but downward trends in smoking and insufficient PA. Filipino adults demonstrated similar trends to Asian Indian adults in alcohol use and smoking. No significant trends were found for other study variables in all three groups. Discussion: U.S. Asian adults from different cultural backgrounds experience varying patterns of cardiovascular health. Public health strategies are recommended to be customized to address the specific cardiovascular risk profiles of each Asian subgroup.

Background: Multimorbidity—coexistence of two or more chronic conditions in the same individual—is a growing global healthcare challenge. Despite recognition of the difficulties in managing multimorbidity, there is a limited understanding of lived experiences and care improvement priorities as identified by key stakeholders. Objectives: The study aimed to explore lived experiences of patients with multimorbidity, their family caregivers, and interprofessional healthcare workers, and to identify shared care improvement priorities. These findings were synthesized into a multimorbidity management toolkit. Methods: An experience‐based co‐design study with six stages was implemented, considering human‐centered design. Participants included patients aged 50 years and above living with heart failure and multimorbidity, family caregivers, and multidisciplinary healthcare professionals recruited in Maryland, USA. Following study preparation and ethical approval (Stage 1), in‐depth individual interviews (Stages 2 and 3) were conducted, and the results were discussed during co‐design events and working group meetings (Stages 4 and 5) to reach a consensus on care priorities and specific strategies. The study findings were summarized into a multimorbidity management toolkit that was shared with participants at a celebration event (Stage 6). Data analysis included descriptive statistics and inductive thematic methods. Results: Forty‐six individual interviews were conducted: 24 patients (mean ± SD age 71 ± 9 years; 54% women; with an average of 8 morbidities), 7 family caregivers (mean ± SD age 64 ± 14 years; 57% women), and 15 healthcare professionals (mean ± SD age 36 ± 10 years). A total of 18 participants attended two co‐design events. Multiple working group meetings were organized to receive diverse input. Four shared care improvement priorities emerged: (1) communication, (2) care coordination and follow‐up care, (3) mental and emotional support, and (4) health education for patients and caregivers. Conclusion: Person‐centered care models that emphasize shared strategies to improve communication, care coordination, education, and emotional support, as outlined in the toolkit, may enhance multimorbidity management and patient outcomes.

Aims: National guidelines recommend implementing team-based care and shared decision-making (SDM) for improving hypertension control and cardiovascular health. However, best practices for integrating SDM into clinical workflows for health behaviour change and medication management in adults with hypertension and multiple cardiovascular disease (CVD) risk factors remains unclear. The study aimed to develop SDM workflows to inform design of patient decision aids to support health behaviour change and medication management of adults with hypertension and multiple CVD risk factors. Methods and results: This study used a modified Delphi method with a geographically diverse panel of 18 interprofessional team members. The process included two Rounds of online Delphi surveys between May and October 2024, followed by a virtual panel meeting in November 2024. Consensus was defined as ≥75% of panelists rating items of the SDM workflow as important or very important with each Round of the online Delphi surveys. Of the 18 expert panelists, the majority was female (n = 15, 83.3%) with a mean age of 49.8 years (standard deviation: 12.9). The Delphi process resulted in two SDM workflows to improve health behaviour change and medication management: one with 70 items focused on hypertension control, and another with 75 items addressing the management of multiple CVD risk factors. Conclusion: The study developed two SDM workflows to support hypertension control and CVD risk factor management. These workflows offer a structured approach to integrating SDM into clinical practice and may serve as a guide for designing patient decision aids in cardiovascular health.

Background: Chronic low back pain (cLBP) is a prevalent and disabling condition in older adults. Auricular point acupressure (APA), a nonpharmacologic intervention, has shown promise in managing cLBP. However, its impact on daily symptom fluctuations remains unclear. Ecological momentary assessment (EMA), which collects real-time data, offers a method to capture these fluctuations. Objective: This secondary analysis evaluated the effects of APA on EMA-reported pain intensity and pain interference among older adults with cLBP and examined associations among APA practice patterns, recall-based assessments, and EMA engagement. Methods: Data were drawn from a published 3-arm randomized controlled trial of 272 adults aged ≥60 years with cLBP, randomized to targeted auricular point acupressure (T-APA), nontargeted auricular point acupressure (NT-APA), or education control. For this analysis, only participants who completed at least one EMA entry during the 4-week intervention were included. A total of 61 participants were excluded due to missing EMA data, resulting in a final analytic sample of 211 (T-APA: 72; NT-APA: 74; and control: 65). EMA-reported pain intensity and interference were collected using a smartphone app 3 times daily over 29 days. Linear mixed-effects models assessed the effects of group assignment and APA practice behaviors on EMA outcomes, adjusting for demographics, smoking, opioid use, and baseline recall-based pain. Spearman correlations assessed associations between EMA and 7-day recall measures. Results: The overall compliance rate was 44.8%, with an attrition rate of 54%. There were no significant differences in compliance or attrition across treatment groups. Older participants showed significantly lower compliance, though attrition was not associated with age. Pain intensity reported via EMA was significantly lower than recall-based pain, while EMA-reported pain interference was higher. EMA and 7-day recall pain outcomes were strongly correlated (Spearman =0.53–0.95; P<.001). Both T-APA and NT-APA, analyzed as separate randomized groups, significantly reduced EMA-reported pain and interference compared to the control. T-APA reduced worst pain (β=–0.98, SE 0.33; P<.001), average pain (β=–0.93, SE 0.30; P<.001), and current pain (β=–1.01, SE 0.36; P=.006). NT-APA also reduced worst (β=–0.74, SE 0.12; P<.001), average (β=–1.02, SE 0.30; P=.001), and current pain (β=–1.26, SE 0.37; P=.001). For interference, T-APA significantly reduced interference with enjoyment of life (β=–1.72, SE 0.37; P<.001) and daily activity (β=–1.41, SE 0.34; P=.001), with similar reductions seen in NT-APA. Conclusions: APA significantly reduced daily pain and interference among older adults with cLBP. EMA provided valuable insights into treatment response and symptom variability. Future research should enhance EMA adherence and explore sustained APA use for self-management. Trial Registration: ClinicalTrials.gov NCT03589703; https://clinicaltrials.gov/study/NCT03589703 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-4016-x

Aim: To examine factors, including symptom burden profiles and self‐care, associated with quality of life among individuals with heart failure and multimorbidity. Design: A cross‐sectional design. Methods: 353 adults aged 50 years or older with heart failure and at least one additional chronic condition were recruited from a university‐affiliated hospital. Three symptom burden groups were identified (low, moderate, and high) through latent profile analysis of the Edmonton Symptom Assessment Scale scores. The Heart Failure Self‐care Index and EuroQoL‐5D‐5L measured self‐care behaviours and quality of life. This study examined group differences and associations overall and stratified by symptom burden groups via multivariable linear regression. Results: A higher disease burden and the high symptom burden group compared to the low symptom burden group were associated with lower quality of life. Self‐care maintenance was positively associated with a higher quality of life, but not in the high‐burden group. Among individual symptoms, pain and depression were associated with lower quality of life. In the high‐burden group, older age was positively associated with quality of life. Higher symptom burden groups included a greater proportion of women and middle‐aged adults. Conclusion: Symptom burden and self‐care maintenance show significant associations with quality of life in multimorbidity. Symptom burden profiles identified through latent profile analysis may complement conventional approaches by targeting high‐risk individuals, such as middle‐aged individuals and women with high symptom burden, for follow‐up and integrated multimorbidity management. Impact: For healthcare providers, including nurses, these findings underscore the importance of holistic, symptom‐based care approaches combined with routine support for self‐care maintenance. Adopting a life‐course approach, through early identification and management of high‐risk individuals, may help promote aging in place with a better quality of life for those with heart failure and multimorbidity. Reporting Method: STROBE checklist. Patient or Public Contribution: No patient or public contribution.

Opinion Statement Symptom management remains a critical priority in oncology, particularly as many survivors continue to experience fatigue, pain, sleep disturbance, neuropathy, and psychological distress despite advances in treatment. Conventional pharmacologic options often provide only partial relief and may be limited by side effects. Acupuncture and acupressure have emerged as promising non-pharmacologic approaches, but the supporting evidence is drawn from a broad and heterogeneous literature. In this opinion paper, we provide a preliminary overview of the current review-level evidence to highlight general trends and evolving areas of promise, while emphasizing the need for further sham-controlled studies to clarify effectiveness and guide integration of acupuncture and acupressure into supportive oncology.

Background: The United Nations Sustainable Development Goals (SDGs) offer a comprehensive global framework for promoting health, equity, and sustainability. Whereas alignment with the SDGs is increasingly encouraged in academic institutions, the extent to which faculty expertise in SDGs influences traditional research impact metrics remains insufficiently explored. Objective: To investigate the relationship between nursing faculty expertise in SDGs and research impact metrics. Methods: A retrospective cross‐sectional design was employed using data from 121 nursing faculty members at Mahidol University, Thailand. Information on SDG‐related expertise and research performance was obtained from the Mahidol University Research Excellence Database (MUREX) and Scopus. SDG expertise was operationalized using SDG alignment data derived from the Scopus Author Profile, which applies machine learning and keyword‐based text mining to map publications to the 17 SDGs. Descriptive statistics, Pearson’s correlation, and multiple linear regression analyses were used to examine associations between SDG expertise, academic experience, and research impact metrics, including H‐index, citation count, and research output. Extreme Gradient Boosting (XGBoost) was applied as a complementary machine learning approach to identify influential features and potential nonlinear patterns, with the Synthetic Minority Oversampling Technique (SMOTE) used to address imbalance in categorical SDG expertise classes. Results: Faculty members with greater expertise in SDGs demonstrated significantly higher research impact metrics. SDG expertise significantly predicted H‐index ( β = 0.65, p < 0.001), total citations ( β = 31.78, p = 0.004), and total research output ( β = 2.41, p < 0.001). Research experience was also a significant predictor of research impact. Machine learning analyses identified SDG expertise breadth and international collaboration as influential features, and faculty aligned with SDG13 (Climate Action) demonstrated a higher proportion of top‐cited publications. Conclusion: SDG expertise is a key determinant of academic impact, reinforcing the need for greater institutional support for SDG‐aligned research. Interdisciplinary collaboration and engagement with broader sustainability challenges may enhance faculty research visibility. Future research should explore longitudinal trends and policy implications for integrating SDGs into faculty assessment frameworks.

Objective: To evaluate the effectiveness of discharge planning interventions in improving health outcomes among individuals with stroke and heart conditions, synthesizing evidence from randomized controlled trials and quasi-experimental studies. Methods: Following PRISMA guidelines, seven electronic databases (PubMed/MEDLINE, Scopus, ScienceDirect, CINAHL Plus with Full Text, Web of Science, Ovid, and ClinicalKey Nursing) were searched for studies published between 2019 and 2024. Eligible studies included adults with stroke or heart conditions who received discharge planning interventions, with outcomes compared to usual care or alternative interventions. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for randomized controlled trials and ROBINS-I for quasi-experimental studies. Data were extracted with a standardized chart and synthesized using a convergent integrated approach in accordance with the Joanna Briggs Institute methodology. Results: Sixteen studies (11 randomized controlled trials and 5 quasi-experimental studies) met the inclusion criteria, representing diverse populations across 11 countries. Interventions included structured discharge programs, early supported discharge, interdisciplinary planning, family-based care, nurse-led eHealth rehabilitation, and technology-enhanced approaches such as SMS, telephone, and interactive voice response systems. Six major outcome themes emerged: (1) healthcare utilization and cost outcomes, (2) patient activation and health behavior change, (3) psychological well-being, (4) functional recovery, (5) health-related quality of life, and (6) caregiver outcomes and support. Although mortality and long-term outcomes showed mixed results, most interventions demonstrated positive short-term effects across clinical, behavioral, and psychosocial domains. Conclusion: Discharge planning interventions improve transitional care and support recovery in stroke and heart disease populations, with particular benefits when multidisciplinary, nurse-led, or digitally supported. This review highlights the value of structured and innovative discharge planning models for clinical practice. Incorporating patient- and caregiver-centered strategies can reduce readmissions, strengthen adherence, and improve long-term health outcomes.

Cancer patients receiving immunotherapy often experience symptoms impacting their well-being. The present study aimed to develop and test the feasibility of a 12-week Technology-Enhanced Home Exercise and acupressure (TEHEplus) program to improve symptoms (fatigue, pain, sleep, anxiety, depression), social functioning, physical performance, and serum biomarkers (brain-derived neurotrophic factor, heat shock protein 90 levels.) A two-phase design was employed. Phase 1 involved program development; Phase 2 was a pilot feasibility study. Participants with solid tumor cancers were recruited from cancer centers in Maryland and randomly assigned to four groups: Usual Care Control (UC), Technology-Enhanced Home Exercise (TEHE) alone, Acupressure alone (ACU), and TEHEplus. Feasibility was measured by enrollment duration, intervention adherence, and daily survey response rates. Outcomes were measured at baseline and program completion. In phase 1, four participants (age 56–82) provided feedback on online training, smartphone application, intervention duration, and outcome measures. In Phase 2, 40 participants (10 per group) were recruited over 12 months, with 43% (n = 17) completing all daily surveys. TEHEplus participants achieved 50% of exercise goals, and 78% adhered to the acupoint recommendations. TEHEplus participants showed significant improvements in fatigue (p = 0.02), pain inference (p = 0.30), and social functioning (p = 0.03); TEHE participants improved only in social functioning (p = 0.03). TEHEplus is feasible and shows promise for symptom alleviation. Preliminary findings suggest potential benefits in symptom management and functional outcomes. However, further studies with larger and more diverse samples are warranted to explore its efficacy and generalizability.Further studies with larger, more diverse populations are needed to confirm its efficacy. TEHEplus may enhance symptom management and improve functional outcomes for cancer survivors undergoing immunotherapy. ClinicalTrials.gov ID NCT03576274 Trial Registration Date: 06/07/2018.

Background/Objectives: Many cancer survivors continue to experience persistent symptoms such as pain, fatigue, and depression. Exercise and increasing physical activity (PA) are recommended as methods that can help alleviate these symptoms. However, maintaining regular exercise can be difficult due to the challenge of maintaining motivation. This secondary analysis uses data from a randomized controlled pilot study that examines the feasibility of the technology-enhanced combined exercise and other nonpharmacological interventions, such as the TEHEplus program, in managing symptoms. The program used mobile technologies and sent weekly physical performance reports to maintain engagement. In this study, we aimed to examine the impact of weekly physical performance reports on daily symptoms and PA and explored characteristics as moderators. Methods: This secondary analysis included participants who completed the 12-week TEHEplus program. Daily data of steps (PA), sleep duration, and symptoms (rated on a 4-point scale) were collected for 84 days. Mixed-effects and lagged regression models were used to assess the impact of weekly physical performance reports and the moderating effects of baseline characteristics. Results: Seventy-seven survivors of solid tumor cancer (mean age, 59.79, SD = 12.17) were analyzed. During this 84-day period, participants reported a reduction in low energy (B = −0.003, p = 0.004). Step counts increased by an average of 141 steps immediately after each weekly report (B = 140.857, p = 0.027). An increase of 5000 steps on the prior day was related to decreasing pain (B = −0.047, p < 0.001) and fatigue/low energy (B = −0.082, p < 0.001). Two additional hours of prior-night sleep worsened pain (B = 0.029, p = 0.001) and fatigue/low energy (B = 0.027, p = 0.002). Gender, employment, race, caregiver, and type of treatments moderate the relationship between daily PA, sleep (B = −0.131~0.078, p_s < 0.05). Conclusions: Weekly physical performance reports promoted PA, which possibly led to self-reported improvement of symptoms. Higher PA was associated with better self-report symptoms, but longer sleep duration was associated with worsened symptoms, suggesting the need for future studies. The moderating effects suggested that tailoring interventions to individual profiles may enhance the program’s effectiveness.