INTRODUCTION:Mothers, especially those with marginalized identities, often struggle to meet physical activity (PA) guidelines. We examined feasibility, acceptability, and preliminary efficacy of Moms on the Move (MOMs), a community-based PA promotion intervention targeting Hispanic and Black mothers delivered in partnership with a youth sports organization in Providence, RI. METHODS:Feasibility targets centered around enrollment (i.e., n>30 participants), retention (i.e., >80% of participants through follow-up), and assessment (i.e., collection of PA data from >80% of participants at multiple timepoints), while acceptability targets centered around participant satisfaction (i.e., >80% of participants being satisfied with the intervention). For preliminary efficacy, we assessed weekly minutes of moderate-to- vigorous intensity PA (MVPA) via 7-Day PA Recall (PAR) at baseline, intervention end (8 weeks), and follow-up (12 weeks), and examined within-person changes in MVPA over time using paired T-tests. Stratified analysis was used to examine differences between participants who were already meeting the national guideline of >150 minutes of MVPA per week at baseline and those who were not. RESULTS:We met recruitment (n=35) and retention (94%) targets but only collected PA data at multiple timepoints from 21 participants (64%). Most participants (94%) were satisfied with the intervention, all (100%) said they learned from the program, and all (100%) said they would recommend participation to a friend. Participants who were not meeting the MVPA guideline at baseline (n=12) reported an increase in MVPA at both intervention end (mean change: 110.27 minutes, Cohen's d: 0.89) and follow-up (mean change: 82.09 minutes, Cohen's d: 0.76). CONCLUSIONS:Findings around recruitment, retention, and participant satisfaction were promising, though assessing MVPA via the PAR, which requires a semi-structured interview, proved challenging. Nonetheless, the findings, which also showed that insufficiently active mothers had significantly higher levels of MVPA at intervention end and follow-up, support testing MOMs in a fully powered, randomized controlled trial.

Approximately 10% of the US Black diaspora were born either in Latin America and the Caribbean (LAC) or Sub-Saharan Africa (SSA), projected to account for a third of the Black US diaspora by 2060. Yet, details on foreign-born Black women’s labor and delivery (L&D) characteristics, such as the type of birth attendant, remain scarce. We used the National Center for Health Statistics 2016 to 2020 Natality data (n = 2,041,880). The associations between detailed maternal nativity (DMN) and the type of attendant at birth (i.e., physician, certified nurse-midwife (CNM), certified professional midwife (CPM)) among US-born, LAC-born, and SSA-born Black women were examined using multivariate multinomial regression. The study revealed that LAC-born women were more likely to have a CNM during birth than US-born Black women, but Haitian-born and Jamaican-born women had lower odds of having a certified professional midwife (CPM) at birth. When compared to US-born Black women, Cameroonian-born women had decreased odds of having either a CNM or CPM during birth. Findings suggest that DMN could be an indicator of cultural preferences in maternity care. There is a need for further investigation beyond DMN and comprehensive data collection methods for future research to understand the specific needs and preferences of different ethnocultural groups to improve maternity care and prevent adverse maternal health outcomes.

This scoping review aims to explore the factors associated with the access, utilization, and experiences of labor and delivery (L D) care services among Black women in the US. Recent findings highlight the systemic healthcare barriers faced by Black women in the US, such as limited access to midwifery care, increased prevalence of severe maternal morbidity, and pregnancy complications. Cultural practices, health beliefs, and past healthcare encounters also influence Black women's preferences and behaviors during L D. The identified gaps in the literature call for more research to understand the factors associated with L D care among foreign-born Black women who deliver in the US. Recommendations emphasize the need for cultural competence training, individual and community support, and policy changes, especially pertaining to access to education about midwifery care and alternative birthing methods and locations to address the disparities and challenges faced by Black women seeking L D care.

PURPOSE:This study evaluated the impact of obesity on cardiometabolic risk factors (CRF) interrelationships and predictive efficiency of CVD development in older African (AA) and European Americans (EA). DESIGN:A comparative research design evaluated CRF risk profile differences between participant groups. SETTING:Seven neighborhoods in a southern US city. SUBJECTS:A sample of 179 older AA (n = 128) and EA (n = 51) adults. MEASURES:Non-fasting blood samples were evaluated for lipids and lipoproteins, glycosylated hemoglobin, systolic -(SBP) and diastolic blood pressure (DBP), body mass index (BMI), body fat percentage (BF%) and physical function. ANALYSIS:Data were analysis with descriptive statistics, t-tests, and correlations. RESULTS:AA were heavier than EA although all had above average age-appropriate fitness. Means and relationships between CRF and other variables were different (P < .05) based on race. Both AA (41.3 + 5.8) and EA (38.6 + 6.4) BF% were CRF risks. Holding BMI constant, CRF were generally not related, and the relationships were different for AA and EA. AA had a range of 13.0 to 27.2% more favorable values for cholesterol, HDL-C, and triglyceride. EA had favorable A1c (EA 5.8 vs AA 6.2%) values. CONCLUSIONS:A limitation of this report is the small sample size. Although further research is warranted, these findings suggest population specific CRF selections would improve CVD prediction in AA.

IntroductionInconsistencies of reports contributes to the underreporting of Alzheimer’s disease (AD) on death certificates. Whether underreporting exists within South Carolina has not been studied.MethodsWe conducted a prospective, population-based study on a cohort of persons (N = 78,534) previously diagnosed with AD and died between 2014–2019. We linked vital records with the South Carolina Alzheimer’s Disease and Related Dementias Registry to investigate their cause of death and survival rates. Descriptive analyses calculated frequencies of demographic and health-related characteristics. Turnbull’s method estimated the survival probabilities for different subgroups of patients. Hazard ratios were computed from the Cox proportional hazards model, adjusting for the following confounding variables of age at diagnosis, education level, gender, and race.ResultsThe top immediate cause of death was Alzheimer’s disease among all racial groups, except for Native American/American Indian. More females (60.3%) were affected by AD compared to males (39.7%). There is a 25% probability of survival, beyond 5 years, after AD diagnosis. Black/African American AD patients have the smallest risk of all-cause mortality across all racial/ethnic groups (HR 0.87; 95% CI, 0.85–0.89). Individuals with lower education had a lower likelihood of mortality.ConclusionAlthough AD was not underreported in the state of South Carolina further research is needed to develop protocols around classification of deaths among those diagnosed with dementia and comorbidities, including cardiovascular disease, to ensure dementia is properly reported as we move to prevent and treat Alzheimer’s disease by 2025 and beyond.

This study aimed to examine the associations between detailed maternal nativity (DMN) and two labor and delivery (L D) characteristics among US-born, Latin American and Caribbean-born, and SSA-born Black women in the US. L D characteristics included the place of delivery (i.e., hospital, birthing center, or home) and the method of delivery (i.e., vaginal or cesarean). Using Natality data, the authors examined the associations between detailed maternal nativity (DMN) and two L D characteristics among US-born, Latin American and Caribbean-born, and SSA-born Black women in the USA who had a live delivery between 2016 and 2020 (N = 2,041,880). The main predictor was DMN (i.e., maternal country of birth) and the outcomes of interest were the place of delivery and the method of delivery. Associations were evaluated using multivariate multinominal and multivariate logistic regression models. Findings indicated that foreign-born Black women overall had decreased odds of delivering in birthing centers or at home, except for Ghanaian-born women who had increased odds of having an unintended home delivery. All Latin American and Caribbean-born and most SSA-born women had increased odds of delivering via cesarean. The findings underscore the importance of considering DMN in exploring L D characteristics. Specifically, increased odds of cesarean delivery among Latin American and Caribbean-born women highlight a potential area for interventions. Further research is warranted to understand the underlying factors driving the observed differences and the diverse needs of the growing population of foreign-born Black women in the US, and to develop effective strategies to promote equitable and optimal birthing experiences for all.

The Paper Chase model is a synchronous collaborative approach to manuscript development. Through a structured and team-based design, authors participate in a “marathon” of writing, editing, revising, and submitting their publications within a specified period. This active-learning approach is considered a high-impact practice by engaging students in research dissemination through a collaborative project. This study sought to evaluate the feasibility and acceptability of a virtual Paper Chase exercise. We conducted the Paper Chase with six teams led by multidisciplinary faculty (with 24 undergraduate students and four graduate students). All participants were given pre-and post-surveys, with both open- and closed-ended questions. Results indicated that the process increased cooperative and problem-solving components of group work attitudes, increased participants’ confidence in writing skills, increased understanding of research processes and that participants appreciated putting their skills immediately into practice. Participants identified strengths as well as opportunities for improvement in online modules and facilitation. The process was effective in that half of the manuscripts were submitted to peer-reviewed outlets within 90 days of the event. The positive evidence for learning in the virtual Paper Chase model supports future applications and may strengthen the involvement of students in research dissemination. Additional research may expand upon the findings by assessing group work dynamics, quality of final products, and conducting the process in a hybrid model.

BACKGROUND:Our documentary, Keepers of the House, highlights ways that hospital housekeepers, typically unnoticed care team members, provide emotional support for patients and their families. This film addresses a gap in education by emphasizing the importance of valuing and reflecting on the unique lived experiences of others. APPROACH:We created this documentary to expose students to the experiences and perceptions of hospital housekeepers. A focus group with six hospital housekeepers informed an interview script for the film's creation. Nine additional housekeepers were then interviewed, which developed into a 15-min documentary. Healthcare students and educators from five disciplines viewed the documentary during their institution's Medical Education Day. EVALUATION:To expose students and educators to housekeepers' experiences, we designed our post-viewing survey to address whether the housekeepers' stories impacted their understanding of the role and value of these workers. Viewers were surprised by the depth and breadth of patient-housekeeper interactions, the trauma housekeepers experienced from patient loss and the pride housekeepers take in their work. The stories that touched the viewers varied but centred on connections between housekeepers and patients. Lessons learned focused on recognizing the contributions of unseen team members. IMPLICATIONS:This innovative documentary amplifies the perspectives of voices rarely heard in healthcare. We aim to use this film, alongside its associated learning session, in education and grand round settings to foster discussion around empathy, valuing underrecognised team members and applying these insights in practice. This work can be disseminated to other institutions, further amplifying underrepresented narratives in healthcare.

Behavior change theory was used to explore predictors of long-term adherence (≥2 years) to exercise. A retrospective analysis of data from participants (N = 97) who reached a 6-month follow-up, which served as the baseline, was evaluated for completion of yearly follow-up surveys. Variables examined at baseline, which included age, race, gender, body mass index (BMI), and self-report of comorbidities, symptoms, physical function, and a Barriers Specific Self-Efficacy Scale, were examined with significance set at p < .05. Lower BMI (29.1 ± 5.1 vs. 31.6 ± 6.5, p = .047) and higher self-efficacy to overcome environmental barriers (p = .016) and social isolation (p = .05) were associated with long-term adherence. Self-efficacy to overcome environmental and social barriers, such as inclement weather, access to exercise site, and opportunities for group-based exercise, should be addressed to promote long-term adherence to exercise among older adults.

Background: Obesity prevalence is higher in women veterans overall than their civilian counterparts considering 44% of women veterans are obese. Thus, there is a critical need to understand the facilitators and barriers to women veterans' participation in weight management programs. The objective of this study is to explore facilitators and barriers to weight loss for women veterans enrolled in the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere (VA MOVE!) weight management program and gather feedback on the design and delivery of the MOVE! program. Materials and Methods: Primary qualitative data were collected from women veterans who completed at least one MOVE! visit via semistructured telephone interviews. Two authors independently reviewed transcripts for data-derived codes. A content analysis approach was used within the software to code the transcripts. Results: The mean age of participants was 52 years. Sixty-eight percent (N?=?17/25) were black, and 52% (N?=?13/25) lived >64 kilometers from the location of the MOVE! program. Facilitators to participation included both intrinsic (e.g., drive to become healthy) and extrinsic (e.g., drive to improve laboratories) motivating factors. Women expressed difficulty with learning in a group setting and applying lessons to their everyday lives. Others reported the setup of group classes triggered their post-traumatic stress disorder and prevented them from fully participating in the program. Additional barriers included distance traveled to group sessions and lack of access to exercise space. Conclusions: Our results illuminate barriers and facilitators to engagement in the MOVE! program. Many of the barriers highlighted by these women veterans mirror barriers civilian women face, highlighting the possibility that our results could be applied to other programs designed to target weight loss in women.

BACKGROUND:Enhanced recovery after surgery (ERAS) is increasingly used in plastic surgery to optimize patient care. Mitigating the risk of postoperative complications is particularly important in patients with risk factors, such as obesity. The objective of this study is to evaluate the impact of the ERAS pathway in patients, stratified by BMI, undergoing free flap breast reconstruction on length of stay and complications.METHODS:A retrospective review of all patients who underwent abdominally based free flap breast reconstruction from January 2014 to December 2017 was performed. Data collected include participation in the ERAS protocol, patient demographics, length of stay (LOS), complications (minor and major), and 30-day reoperation rates.RESULTS:A total of 123 patients met the inclusion criteria, with 36 non-ERAS and 87 ERAS patients. ERAS patients had a shorter length of stay than non-ERAS patients (4.14 vs. 4.69, p = 0.049). Higher BMI patients progressively benefited from their involvement in an ERAS pathway: class I obese patients had an LOS decrease of 0.99 days (p = 0.048) and class II+ obese patients had an LOS decrease of 1.35 days (p = 0.093). Minor complications, major complications, and reoperation rates were similar between ERAS and non-ERAS patients (p>0.05).CONCLUSION:Utilization of an ERAS protocol for free flap breast reconstruction safely decreases LOS, especially with increasing BMI. Patients benefit from an ERAS protocol without increasing risk of postoperative complications, compared to non-ERAS patients of similar BMIs.

I have loved gerontology since before I knew it was a discipline. I volunteered in a nursing home the summer after my 8th grade year and knew then I wanted to work with older adults. I sought out t...

There is a paucity of information on motivation among U.S. minority triathletes. This study aimed to understand the extrinsic motivation and regulators of Black women triathletes using a modified version of the valid Motivations of Marathoners Scale and semi-structured interviews, for triathletes. The Self Determination Theory guided the dual method assessment of the extrinsic motivators and the regulators external, introjection, and integrated. Using MANOVA, data from (N = 121) triathletes were compared across participant categories of age, body mass index, and distance. Results showed a significant age difference with younger women displaying more motivation. Descriptive means indicated integration as the greatest regulator of motivation. The statements ‘to compete with myself’ and ‘to be more fit,’ had the highest means among the women. A sub-sample of 12 interviews were conducted revealing 16 extrinsic themes. Six were related to the regulator integration and two unexpectantly related to the regulator, identified. Integrated themes, including coping mechanisms, finishing course, improvement, accomplishment, and physical awareness were most represented. This research fills gaps of understanding extrinsic motivation and the regulators of a group not previously explored. Future research on motivation among triathletes may benefit knowing how motivations are regulated, as to promote personalized training and participation.

Abstract Rural Veterans often lack access to health care. Veterans Affairs (VA) supports telehealth technologies to provide services remotely that are comparable to onsite in-person care. We piloted VA Video Connect (VVC), to deliver an interactive exercise program for Veterans modeled on the VA Gerofit Program, a successful facility-based exercise program. VVC connects an exercise physiologist directly to the home with smart devices. Invitations to join Gerofit were mailed to 216 rural Veterans. Of 17 respondents, 7 (mean age 68) agreed to VVC tele-exercise 1x week for 12 weeks. Two Veterans were lost to follow-up prior to enrollment. Baseline VVC assessments (N=5) were indicative of high functional impairment in comparison to age-based norms: 2-minute step test (67.2 steps, 5th%tile), 30-second chair stands (12.4 stands, 26th%tile), and 30-second arm curls (15.3 curls, 25th%tile). Feasibility, barriers, and program impact will be discussed. Functional impairment indicates need for telehealth to reach Rural Veterans.

Assistant Physician to the Massachusetts General Hsopital. Third edition revised and enlarged. Mass. Price, $1.50.

Pelvic venous insufficiency is now a well-characterized etiology of pelvic congestion syndrome (PCS). The prevalence of CPP is 15% in females aged 18 to 50 years in the United States and up to 43.4% worldwide. In addition to individual physical, emotional, and quality-of-life implications of CPP, there are profound healthcare and socioeconomic expenses with estimated annual direct and indirect costs in the United States in excess of 39 billion dollars. PCS consists of clinical symptoms with concomitant anatomic and physiologic abnormalities originating in venous insufficiency. The etiology of PCS is diverse involving both mechanical and hormonal factors contributing to venous dilatation (>5 mm) and insufficiency. Factors affecting the diagnosis of PCS include variance of causes and clinical presentations of pelvic pain and relatively low sensitivity of noninvasive diagnostic imaging and laparoscopy to identify insufficiency compared with catheter venogram. A systematic review of the literature evaluating patient outcomes following percutaneous treatment of PCS is presented.

OBJECTIVE: To evaluate whether extended-release gabapentin is more effective than placebo among women with vulvodynia. METHODS: In a multicenter double-blind, placebo-controlled randomized crossover trial, gabapentin (1,200–3,000 mg/d) was compared with a placebo. The primary outcome was mean pain intensity (0, no pain at all to 10, worst pain ever) on the tampon test (a standardized tampon insertion and removal test used as a surrogate marker for dyspareunia) during the last 7 days of the maintenance phase. Secondary outcomes included sexual intercourse pain and daily pain. A sample size of 53 provided 90% power to detect a 1-point reduction on the tampon test (.05 level, two-sided) between the two treatment phases. RESULTS: From August 2012 to January 2016, 230 women were screened at three academic institutions and 89 (mean age 37 years; 65% black) were randomized: 45 to gabapentin first and then placebo and 44 to placebo first and then gabapentin. Tampon test pain with gabapentin was not different compared with the placebo (adjusted mean 4.0, 95% CI 3.0–4.9 vs 4.3, 95% CI 3.4–5.2, difference −0.3, 95% CI −0.7 to 0.0; P=.07). Gabapentin also did not improve pain over placebo for sexual intercourse pain (adjusted mean 3.9, 95% CI 2.4–5.3 vs 4.0, 95% CI 2.5–5.4, difference −0.1, 95% CI −0.9 to 0.6; P=.76) and daily pain (adjusted mean 2.7, 95% CI 1.8–3.6 vs 2.9, 95% CI 2.0–3.8, difference −0.2, 95% CI −0.5 to −0.2; P=.36). Subset analyses found that longer pain duration and oral contraceptive nonuse were associated with minimal improvement in tampon test pain with gabapentin. CONCLUSION: In this cohort, extended-release gabapentin, as compared with a placebo, did not reduce tampon test pain. These data do not support the recommendation of gabapentin alone as treatment for vulvodynia. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01301001.