Purpose:Disparities in cognition among middle-aged and older African American/Black adults are evident, especially among people living with HIV (PLWH). Though disparities in health literacy among African American/Black adults impact health outcomes across clinical populations, its role in racial differences in cognition among PLWH is not well understood. This study aimed to determine if health literacy mediated racial differences in cognition among PLWH and people living without HIV (PLWoH). Patients and methods:Measures of oral word literacy (Wide Range Achievement Test-3rd Edition), health literacy (Test of Functional Literacy in Adults - Reading Comprehension subtest, Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign, Expanded Numeracy Scale), and cognition (gold standard neurocognitive battery) were examined in 273 participants (170 PLWH: 86% African American/Black; 103 PLWoH: 65% African American/Black) via secondary analysis. Multivariable linear regressions (MLRs) among PLWH and PLWoH examined associations between health literacy and cognition, accounting for relevant covariates, followed by adjusted bootstrap confidence interval mediation analyses to determine whether health literacy mediated the association between race and cognition. Results:In both samples, White people scored higher than African American/Black people on measures of cognition, health literacy, oral word literacy, and SES. Adjusted MLRs in PLWH and PLWoH separately showed health literacy was associated with cognition (PLWH: b = .205, p = .007; PLWoH: b = 0.354, p = .002). Health literacy significantly mediated the association between race and cognition, independent of covariates (PLWH: effect = .055, 95% CI [0.0048, 0.1973]; PLWoH: effect = .093, 95% CI [0.0276, 0.1827]). Conclusion:These results underscore the importance of health literacy in explaining racial disparities in cognition among African American/Black PLWH and PLWoH in the Deep South. Findings have implications for guiding the development of health literacy interventions, which may have downstream positive impacts on cognition.
Purpose:Despite evidence that: 1) older people living with HIV (PLHIV) experience a high burden of stress that is associated with myriad poorer outcomes, 2) psychological resilience may buffer the negative effects of stress in older PLHIV, and 3) older PLHIV may possess lower levels of this protective factor than seronegative counterparts, little work has examined strategies to bolster resilience in older PLHIV. This article details the protocol for a pilot clinical trial examining the feasibility and efficacy of a theory-driven resilience intervention that has been adapted for older PLHIV. Patients and Methods:This study plans to randomize 100 older PLHIV aged 45+ with suboptimal HIV treatment management to either an intervention condition (i.e., Resilience Intervention for Successful Aging Enhancement [RISE+]) or an attention-matched control condition. Both arms include weekly one-hour in person group intervention sessions. The comprehensive assessment includes proximal mechanistic measures, (i.e., real-time measurement of resilience resources and stress reactivity and recovery via experience sampling method [ESM] text message-prompted online surveys) and health (i.e., psychological functioning and HIV outcomes) measures. Primary Aims focus on intervention effects on: the use of resilience resources and whether such increases drive improved affective stress reactivity and recovery (Aim 1) and distal health outcomes at three months (Aim 2). Conclusions:This study tests a novel resilience intervention among older PLHIV and has several strengths, including focusing on an at-risk and understudied population, rigorous examination of efficacy and mechanism, and utilizing an intervention with minimal facilitator involvement, which has implications for future scalability. Findings will identify intervention mechanisms and inform the development of potent and scalable interventions for building resilience in older PLHIV and other diverse populations of older adults.
Background and Purpose:Cognitive intra-individual variability (IIV) refers to the fluctuations observed in cognitive performance. The aim of this article was to characterize and describe for illustrative purposes an approach to administer executive functioning training to people living with HIV (PLWH) to reduce their cognitive IIV. This brief report highlights four cases in an on-going study investigating cognitive IIV in HIV. In HIV, cognitive IIV has been associated with cognitive decline, cortical atrophy, and mortality risk. The Executive Dysfunction Hypothesis suggests improving executive functioning could reduce cognitive IIV. Study Design:In the parent on-going pilot RCT (called the Executive Functioning Training (EFT) Study), 120 PLWH are randomized to either a no-contact control group or an executive functioning training group which receives 20 hours of computerized exercises. To characterize this study, this article describes an interim descriptive case analysis (N=4) that was conducted with the first two participants who completed training (n=2) and compared to demographically-matched control (n=2) participants. Results:Using the Connor's Continuous Performance Test 3rd Edition, results showed improvements in reaction time (Hit RT, by -24.5 points) and cognitive IIV (HRT SD, Variability, by -16 points) in the training group compared to the no-contact control group. In other words, the training appeared to reduce cognitive IIV. Conclusion:This finding suggests that by improving executive functioning through executive functioning training, this may stabilize cognitive functioning in general, as indicated by reduced cognitive IIV. Although preliminary, these encouraging results support the Executive Dysfunction Hypothesis and suggests further exploration of cognitive IIV may provide insights on how to improve cognition in aging PLWH. Implications for neuroscience nursing are provided.
Background:Consistent adherence to prescribed hypertension treatment regimens is an important goal for persons living with hypertension, yet it remains a challenge for minority and underserved populations. Employing technology-based intervention (TBI) to support self-managing hypertension presents an opportunity to effectively control BP, and potentially have long-term effects on health outcomes. Objective:The objective of this study is to test the efficacy of a TBI, OPtimizing Technology to Improve Medication Adherence and BP Control (OPTIMA-BP), as an approach to support hypertension self-management to improve BP, health-related quality of life (HRQOL), and long-term compliance in African Americans with hypertension. Methods:This prospective, 2-arm randomized trial conducted in the Midwest will enroll African American older adults with hypertension, 50 years of age and older, recruited from primary clinics and community settings. Participants are allocated in a 1:1 ratio using computer-generated randomization to OPTIMA-BP intervention (n = 104) or Waitlist control group (n = 104). Participants are asked to participate in the study over a 12-month period and complete 5 study visits. Individuals in the OPTIMA-BP intervention group will receive three technology components (web-based education, medication adherence mHealth app, study provided home BP monitor), coupled with nurse counselling and communication to providers for guideline-directed treatment regimen. We will also collect data on knowledge-attitude mechanisms of self-management (hypertension knowledge, self-efficacy, perceived social support) and proximal behavioral mechanisms (antihypertension medication-taking, diet, exercise). Qualitative analyses will explore participants' experiences with self-managing hypertension using technology. Results:Participant recruitment began in March 2022, and is currently ongoing. It is anticipated that preliminary findings appropriate for analysis will be disseminated Summer 2025. The primary endpoint is a change in BP (<130/80 mmHg) and improved HRQOL. Conclusion:Using TBI along with standard preventive measures provides a unique opportunity to improve BP control and enhance secondary CVD prevention in this high-risk group. Trial Registration:ClinicalTrials.gov NCT05564728; https://clinicaltrials.gov/study/NCT05564728.
Background and Purpose:Cognitive training programs have been attempted to improve cognition in cognitively vulnerable people living with HIV (PLWH). Some have attempted to improve episodic memory or speed of processing, while others have used an individualized cognitive domain approach targeting each person's cognitive deficits. Although effective, none of these approaches considered the influence of cognitive intra-individual variability (IIV). Cognitive IIV refers to the fluctuations in one's individual cognitive ability across cognitive domains (dispersion) or within the same test (inconsistency). Greater cognitive IIV predicts cognitive decline as well as decreased cognitive integrity and increased neuropathology. Some neuroscientists posited that poor executive functioning, known as the Executive Dyscontrol Hypothesis, increases cognitive IIV. Thus, if we can improve executive functioning, we may be able to decrease cognitive IIV and improve overall cognitive functioning. This article provides the rationale and protocol for a feasibility clinical trial examining an executive functioning training intervention in middle-aged and older PLWH. Study Design:This study utilizes a two-arm baseline/posttest experimental design to examine the primary aim 1 (feasibility and acceptability) and the exploratory aim 1 (cognition) in 120 community-dwelling PLWH aged 40 and older. Participants will be randomized into one of the two arms: 1) 20 hours of computerized executive functioning training group, or 2) a no-contact control group. The proposed training time is 10 to 12 weeks (1 to 2 one-hour training sessions/week, while working around participants' schedules). At baseline and posttest, participants will receive a 1.5 to 2-hour assessment that includes many measures including the Connor's Continuous Performance Test (Version 3), and a 50-minute self-administered computerized cognitive performance battery (BRACE+ = BrainBaseline Assessment of Cognition and Everyday Functioning). Conclusion:This study tests an innovative intervention designed to reduce cognitive IIV; to our knowledge, no other study has targeted cognitive IIV as an intervention outcome.
Chronic obstructive pulmonary disease (COPD) is a fatal chronic disease experienced by 10% of people living with HIV (PLWH). As the population of older PLWH continues to increase, the prevalence of COPD is anticipated to grow as well. Despite this concerning trend, there is a lack of theoretical models to guide clinical practice and research on aging with HIV and COPD. To address this gap, this article describes the Baltes and Baltes' SOC (Selective Optimization with Compensation) Model as a guiding framework for understanding successful aging of PLWH with COPD. The article highlights eight areas of aging (eg, length of life, biological health, mental health, cognitive efficiency, social competence, productivity, personal control, and life satisfaction) with HIV and with COPD and the potential synergetic effects of having two critical chronic diseases. Drawing from a synthesis of literature, we adapted the SOC model to include dedicated areas specifically tailored for HIV, COPD, and the intersectional areas impacted by both conditions. Furthermore, we integrated bidirectional relationships within the eight areas of aging into the model, aiming to enhance the practical application of the modified model. Based on the identified gaps in the literature, implications for clinical practice, research, and future theoretical developments are provided.
BACKGROUND & PURPOSE:African Americans (AAs) are twice as likely to develop dementia than Whites, which may be driven by poorer dementia knowledge and lifestyle factors. This article provides the rationale and protocol for a pilot clinical trial examining a tailored multi-domain lifestyle modification intervention in middle-aged and older AAs. This study will explore the feasibility and efficacy of individualized Cognitive Prescriptions (CogRx) which target five domains: physical activity, cognitive activity, diet, sleep, and social activity. Theoretical underpinnings include Social Cognitive Theory and the Health Belief Model, which suggest that tailored risk factor information, goal-setting, and outcome expectations along with addressing self-efficacy and barriers will promote behavior change.STUDY DESIGN:This study plans to enroll 150 community-dwelling AA participants aged 45-65 without significant cognitive impairment. After baseline assessment including data-driven assessment of deficiencies in each of the five CogRx domains, participants are randomized with equal allocation to either: psychoeducation + CogRx, psychoeducation only, or no-contact control. The psychoeducation and CogRx groups receive general psychoeducation on dementia prevalence, prognosis, and risk factors, while the CogRx group also receives information on their risk factor profile and develops a tailored 3-month intervention plan, consisting of simple evidence-based strategies to implement. The CogRx condition receives text-messaging reminders and adherence queries and provides feedback on this program.CONCLUSION:This study tests a novel multi-domain dementia prevention intervention and has several strengths, including enrolling middle-aged AAs with a focus on prevention, assessing adherence and self-efficacy, tailoring the intervention, and examining dementia knowledge. The goal is to yield new perspectives on person-centered dementia prevention approaches in diverse populations, and ultimately impact clinical and public health recommendations for maintaining cognitive health, thereby reducing disparities in dementia. Modifications to study design due to COVID-19 and future directions are discussed.
Purpose:Cognitive deficits are a concern for breast cancer survivors, as these effects are prevalent and impact daily functioning and quality of life (QoL). The purpose of this study was to examine the effects of a speed of processing (SOP) training intervention on secondary, self-reported health outcomes in this population.Methods:Sixty middle-aged and older adult women breast cancer survivors completed baseline assessments and were randomized to either a no-contact control group or an SOP training group, who completed 10 hrs of computerized SOP training online at home. Both conditions completed self-report surveys of sleep, QoL, cognitive difficulties, and depressive symptoms at six weeks and six months post study entry.Results:There were no significant effects of the SOP training on self-reported health outcomes.Conclusion:Future studies examining the effect of cognitive training on self-reported health outcomes are warranted that include individuals with baseline impairment in such indices in order to better determine efficacy, and longer follow-up time points may aid in examining the protective effects of this intervention in those without baseline impairment.
For centuries, since the advent of harnessing magnetic and electrical energies, humans have been applying such energies to various body parts, including the brain, with the goal of improving health. Advancements over the past two decades in the production and affordability of such devices that precisely deliver such energies have resulted in novel therapeutic uses. One technique in particular, transcranial Direct Current Stimulation (tDCS), uses electrodes placed on the scalp to deliver a low electrical current to various areas on the surface of the neocortex. Such electrical currents stimulate neurons, which depending on the area of the neocortex it is applied and certain stimulation parameters, can either excite or inhibit certain functions within the brain that may result in alterations in mood, cognition, and behavior. This article provides an overview of this approach, explains how it is used, describes the hypothesized neurobiomechanisms involved, and explores its therapeutic potential. From this overview, implications for nursing practice and innovative uses for nursing research are posited.
The current study was conducted by performing secondary analysis of data drawn from a study of sustained work indicators of older farmers. The primary outcome variable was the reported occurrence or non-occurrence of injuries because of farm work in the past year. There were three explanatory variables of interest: (1) whether respondents reported ever having been diagnosed with arthritis/rheumatism by a medical doctor; (2) whether participants reported having mobility problems; and (3) a farm task injury risk index. Additional explanatory variables included the estimated number of days spent on farming activities in the past year, as well as demographic characteristics such as age, sex, and race. Institutional review board approvals were obtained for the original study prior to data collection, and for the current study prior to secondary analysis of data. Descriptive statistics were calculated for the outcome and explanatory variables. Initial multivariable longitudinal models for the occurrence of injuries were fitted with the explanatory variables. Odds ratios for the effects of interest were calculated using the final models. A longitudinal model was fitted using data in waves 1, 3, and 5, with a farm task injury risk index as outcome variable and wave, sex, age, race, and estimated number of days spent on farming activities in the past year as explanatory variables for exploration of the relationship between the farm task injury risk index and these variables. In this group of older farmers, aging was protective for injury, and was associated with decreased farm task injury risk index. Arthritis/rheumatism was associated in our study with occurrence of injury because of farm work across all four waves. Our results indicated that farmers with mobility problems were twice as likely to experience injuries because of farm work compared to farmers with no mobility problems. Increased farm task injury risk index was associated with a 40% increase in odds for the occurrence of injury due to farm work. In this study of older farmers, the type of work, and not the amount of work was significantly associated with injury risk. Implications for future studies of farm injury include the need for nurse researchers and others to incorporate objective validated measures of mobility and health care provider diagnoses of arthritis, and arthritis type. Nurse researchers should proceed with ongoing evaluation of the farm task injury risk index to determine its validity, reliability, and usefulness as a predictor of farm injuries. In the practice setting, nurses may apply findings from this study to provide injury prevention teaching to older farmers and their families. For example, discussions of the more risky farm tasks, injury prevention strategies, and treatment modalities including those that promote improved mobility should be targeted to older farmers with arthritis and actual or potential mobility issues. Ultimately, these nursing research and practice efforts may lead to preservation of function, and decreased injury risk and severity among older farmers.
BACKGROUND: Nationally, African American (AA) girls aged 15 to 19 have the highest incidence of Chlamydia, gonorrhea, and syphilis compared to White and Hispanic girls of the same age group. To address this STI epidemic, it is imperative to target AA girls during early adolescence and before sexual debut. According to the 2011 National Youth Risk Behavior Survey, approximately 7% of AA girls initiate sex prior to age 13. The purpose of this descriptive, qualitative study was to explore AA girls', aged 12 to 14, perceptions about virginity and relationships and how those perceptions influence their decisions to engage in or abstain from sexual activity. METHODS: A convenience sample of 64 participants was recruited through community-based organizations in Alabama. Data were collected using individual interviews and focus groups. Individual interview focused on (1) values and beliefs about being a virgin, (2) choosing boyfriends, and (3) perceptions about good and bad relationships. Focus groups were held to validate findings from interviews. Verbatim transcripts of audiotapes, observation notes, and demographic data were primary data for analysis. Content analysis was used in analysis and interpretation of qualitative data to formulate meaningful categories, themes, and patterns. The qualitative research software, QSR N-Vivo®, was used to code and sort data into categories. The SPSS statistical software was used to conduct descriptive analyses to describe the study sample. RESULTS: Mean age of study sample was 12.9 years. Out of 64participants, 5 reported having engaged in sexual activity. Mean age of sexual debut was 13 years. Common themes that emerged included: respecting myself, ideal boyfriend, characteristics of a romantic relationship. CONCLUSIONS: Findings from this study suggest STI prevention programs should build upon the values related to virginity to promote delaying sexual activity. Furthermore, findings suggest the need for education about healthy relationships.
