The COVID-19 pandemic has inflicted global devastation, infecting over 750 million and causing 6 million deaths. In an effort to control the spread of the virus, governments around the world implemented a variety of measures, including stay-at-home orders, school closures, and mask mandates. These measures had a substantial impact on dietary behavior, with individuals discussing more home-cooked meals and snacking on social media.

The study explores pandemic-induced dietary behavior changes using Twitter images and text, particularly in relation to obesity, to inform interventions and understand societal influences on eating habits. Additionally, the study investigates the impact of COVID-19 on emotions and eating patterns.

In this study, we collected approximately 200,000 tweets related to food between May and July in 2019, 2020, and 2021. We used transfer learning and a pretrained ResNet-101 neural network to classify images into 4 health categories: definitely healthy, healthy, unhealthy, and definitely unhealthy. We then used the state obesity rates from the Behavioral Risk Factor Surveillance System (BRFSS) to assess the correlation between state obesity rates and dietary images on Twitter. The study further investigates the effects of COVID-19 on emotional changes and their relation to eating patterns via sentiment analysis. Furthermore, we illustrated how the popularity of meal terms and health categories changed over time, considering varying time zones by incorporating geolocation data.

A significant correlation was observed between state obesity rates and the percentages of definitely healthy (r=-0.360, P=.01) and definitely unhealthy (r=0.306, P=.03) food images in 2019. However, no trend was observed in 2020 and 2021, despite higher obesity rates. A significant (P<.001) increase in the percentage of healthy food consumption was observed during (39.99% in 2020) and after the shutdown (39.32% in 2021), as compared with the preshutdown period (37.69% in 2019). Sentiment analysis from 2019, 2020, and 2021 revealed a more positive sentiment associated with dietary posts from 2019. This was the case regardless of the healthiness of the food mentioned in the tweet. Last, we found a shift in consumption time and an increase in snack consumption during and after the pandemic. People ate breakfast later (ie, from 7 AM to 8 AM in 2019 to 8 AM to 9 AM in 2020 and 2021) and dinner earlier (ie, from 6 PM to 7 PM in 2019, to 5 PM to 6 PM in 2020). Snacking frequency also increased. Taken together, dietary behavior shifted toward healthier choices at the population level during and after the COVID-19 shutdown, with potential for long-term health consequences.

We were able to observe people's eating habits using social media data to investigate the effects of COVID-19 on dietary behaviors. Deep learning for image classification and text analysis was applied, revealing a decline in users' emotions and a change in dietary patterns and attitudes during and after the lockdown period. The findings of this study suggest the need for further investigations into the factors that influence dietary behaviors and the pandemic's implications of these changes for long-term health outcomes.

Rising health care costs and chronic disease prevalence have increased concerns about health-related financial burden. This study examined how baseline chronic disease burden was associated with subsequent perceptions of financial control ∼9 years later.

Data came from the Midlife in the United States (MIDUS) cohort, with MIDUS 1 and 2 used as baseline predictors for future perceived financial control outcomes at MIDUS 3. Adjusted mixed effect models examined the relationship between baseline chronic disease burden on 4 variables representing future perceptions of financial control.

A total of 3297 participants [mean (SD) age: 54 (11.36) y] were included. Greater chronic disease burden and medication use at baseline were associated with a higher likelihood of inadequate resources [adjusted odds ratio (AOR) = 1.22; 95% CI: 1.07-1.38; P = 0.001 and AOR = 1.29; 95% CI: 1.13-1.46; P = 0.001, respectively]. Having more chronic conditions predicted reduced feelings of financial control (AOR=0.85; 95% CI, 0.78-0.93; P <0.001) and a more pessimistic financial outlook (AOR = 0.87; 95% CI: 0.79-0.97; P < 0.01). Higher baseline cholesterol levels showed mixed associations: better perception of current finances (AOR = 1.36; 95% CI: 1.22-1.51; P =0.001) but reduced sense of financial control (AOR = 0.86; 95% CI: 0.78-0.95; P < 0.001) and more negative financial outlook (AOR = 0.69; 95% CI: 0.62-0.77; P < 0.001). No baseline factors predicted bill payment capability.

The findings suggest a need for additional strategies to reduce the financial burden of chronic diseases.

Diabetes and prediabetes are some of the most prevalent and expensive diseases. The role and support of the family are some of the most helpful variables in managing and preventing diabetes and prediabetes. The aim of this study is to examine the intervention based on the family health nurse model on the anthropometric and glycemic indicators of middle-aged prediabetics.

This randomized clinical trial study will be conducted from January to March 2024 in selected healthcare facilities in Isfahan City. Using a table of random numbers, 72 eligible people will be randomly selected from the intervention and control centers to participate in the study. After getting written consent, a list of the families' health-related issues, resources, and challenges will be gathered by visiting the clients' homes. Then, family health nurse model-based interventions are put into place for them. By carrying out the necessary tests, information will be gathered. Software called SPSS 26 will be used for data analysis.

Determining the effectiveness of the Family Health Nurse (FHN) model on the control and prevention of diabetes can offer a suitable framework for providing family-oriented services to middle-aged people with prediabetes and improving their health by considering social factors, such as family.

This study measured the impact of macronutrient composition of a pre-fast meal on time-to-ketosis and other metabolic indicators of glycemic control during a 24-hr fast within a population of older, sedentary, overweight adults.

Twenty-four adults who were over the age of 50, sedentary (< 150 min of weekly exercise), and overweight (BMI ≥ 27) participated in a randomized crossover study. Each of these inclusion criteria have been shown to increase the risk for the development of chronic diseases. Participants began each 24-hr fast with either a high carbohydrate/low fat/moderate protein (HC/LF) or an isocaloric low carbohydrate/high fat/moderate protein (LC/HF) shake. Metabolic indicators included subcutaneous glucose readings every 15 min throughout the study, capillary beta-hydroxybutyrate (BHB), and plasma concentrations of insulin, glucagon, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP). Measurements of these hormones took place at 0, 1, 24, and 48 h, and BHB measurements took place at 0, 1, 4, 8, 12 and 24 h.

Glucose levels were higher in the HC/LF group 15 min to 2.25 h after fast initiation (p < 0.05 for all). There was a significant condition by time interaction for BHB (F = 3.84, p < 0.01). Nutritional ketosis (BHB ≥ 0.5 mmol/L) was reached on average by 12 h in the LC/HF condition but was not reached at any point during the fast on average in the HC/LF condition. An hour after consuming the LC/HF shake insulin was 41.9% lower (t = 6.13, p < 0.01), glucagon 23.6% higher (t = -4.72, p < 0.01), GLP-1 26.8% higher (t = -5.16, p < 0.01), and GIP 34.4% higher (t = -3.41, p < 0.01) compared to the HC/LF shake.

A low carbohydrate pre-fast meal can reduce time-to-ketosis in older, sedentary, overweight adults. Those looking to improve glycemic control through fasting or time-restricted eating interventions may consider the macronutrient composition of their pre-fast meal to improve its efficacy.

Free clinics are a widespread, yet limited research has examined the health status of people served and the cost effectiveness of free clinics. The purpose of this study was to describe the sociodemographic characteristics and prevalence of chronic conditions in patients seen at a free clinic and estimate the clinic's cost-effectiveness. The study was a retrospective chart review of 350 randomly selected paper medical charts (2009-2020) and 1,676 electronic medical records (2020-2022) at the Noor free clinic in California supported by private donors, non-profits, and foundations. Cost-effectiveness was calculated from annual clinic operating costs, services provided, quality-adjusted life years (QALYs) saved, and projected savings from preventing emergency department visits. Of the 350 paper charts reviewed, 336 met inclusion criteria. Patients had an average age of 46.6 years, with most identifying as female (60%), Hispanic (69%), Spanish-speaking (62%), and employed (59%). About 64% had incomes below the federal poverty line. Chronic conditions included overweight/obesity (75%), chronic pain (46%), hypertension (28%), hyperlipidemia (24%), type 2 diabetes (24%), and mood disorders (23%). A quarter of patients had at least one chronic condition, and over half had multiple conditions. The clinic's services in 2022 resulted in an estimated 146 QALYs saved, $11.5 million in cost savings, and a return on investment of $13.18 per $1 invested. The free clinic provided medical care to low-income, Hispanic populations without insurance who historically have been disenfranchised from healthcare access. Cost-effectiveness analysis suggested that it provided significant health benefits and cost savings.

The increasing prevalence of multimorbidity and the co-occurrence of multiple chronic diseases presents a measurable challenge to public health, impacting healthcare strategies and planning. This study aimed to explore disease patterns and temporal clustering using data from South Korea's National Health Insurance Service, spanning 2002-2019. The dataset included approximately 1 million individuals, focusing on those with at least two chronic diseases while excluding individuals who died within five years of follow-up. We analyzed 126 non-communicable diseases, considering only those with a prevalence above 1%, and applied a wash-out period to determine incidence. Exploratory factor analysis (EFA) and non-negative matrix factorization (NMF) were used to identify disease clustering over time. Participants were divided into four groups: men and women in their 50 s and 60 s. EFA identified five patterns in men in their 50 s and seven in their 60 s, while four patterns emerged in women in their 50 s and five in their 60 s. NMF identified 10 clusters for men in their 50 s, 15 in their 60 s, and 16 clusters for women in both age groups. Our study confirms established comorbidity patterns and reveals previously unrecognized clusters, providing data-driven insights into multimorbidity mechanisms and supporting evidence-based healthcare strategies.

Background: Head Start, a federally funded preschool for low-income families, offers a unique space for interventionists to equitably reach parents and children, and promote healthful behavior for chronic disease prevention. However, determinants of implementation in this context remain understudied, hindering opportunities for improvement. We aim to identify organization-level factors affecting implementation of an obesity prevention program, as relayed by implementation partners at Head Start. Methods: Communities for Healthy Living (CHL), designed and implemented with Greater Boston Head Start (n = 16 programs across n = 2 agencies), is a cluster-randomized obesity prevention trial offering enhanced nutrition support, media campaign, and a parenting program. The current study draws on two years (2017-19) of data collected from Head Start implementation partners. Pre-implementation, staff completed anonymous surveys: implementation readiness (n = 119), staff training evaluation (n = 166), and facilitator training evaluation (n = 22); response frequencies were tabulated. Mid-implementation, staff and leadership participated in focus groups (n = 3 groups with n = 16 participants) and interviews (n = 9); transcripts were analyzed using a deductive-inductive hybrid approach, grounded in the Consolidated Framework for Implementation Research. Results: Most staff strongly agreed or agreed they understood their role (98.8%), planned on recruiting parents (98.2%), and reported commitment to implementation (92.5%); however, fewer identified CHL as a priority (69.7%) and were confident in their ability to coordinate efforts (84.9%), handle challenges (77.3%), and receive support (83.2%). Thematic analysis yielded implementation facilitators, including mission alignment, partner engagement in design, allocation of intervention-specific resources, and expressed leadership support. Barriers included strains imposed on staff workflow, a lack of shared responsibility, and challenges in coordinating CHL activities amidst competing Head Start programs. Conclusions: Responsive efforts to address deliverer-identified barriers to implementation may include reducing intervention impact on preexisting workflow, as well as clearly distinguishing intervention activities from preexisting Head Start programs.

Discharge against medical advice (DAMA) is used in healthcare facilities in a situation where patients refuse care or decide to leave the hospital before the treating physician recommends discharge. Previous studies have found DAMA to be prevalent among patients with various chronic conditions. The study had four objectives. The study aimed to investigate: (1) the prevalence of DAMA during COVID-19 (2020-2021) among Jordanian patients with chronic diseases, (2) the association between DAMA and sociodemographic and clinical characteristics of patients with chronic diseases, (3) the predictors of DAMA and (4) the reasons behind DAMA at the patient, hospital and environmental levels.

A descriptive cross-sectional correlational design was used in the study. A convenience sampling approach was used to collect data from 1576 patients with chronic diseases from 3 private hospitals.

The study found that the prevalence rate of DAMA was 33.3%. There was a significant association between the sociodemographic and clinical characteristics of patients with chronic diseases and DAMA. Health insurance found to be the strongest predictor of DAMA. Finally, the study found that patient, hospital and environmental-related factors had a low impact on DAMA.

DAMA is prevalent among patients with chronic diseases in Jordan during COVID-19 pandemic. The current study's findings can serve as an empirical basis for planning and implementing DAMA prevention programs and/or establishing or revising policies for the target population.

Several recent reports have indicated positive health benefits of consuming (-)-epicatechin-rich cocoa products. Postmenopausal women are predisposed to reduced metabolism due to decreased levels and activity of the sex hormones estrogen, progesterone, and estradiol. The purpose of this study was to investigate the influence of dark chocolate consumption on resting and exercise metabolism in postmenopausal women. Using a randomized, double-blind design, 26 postmenopausal participants were assigned to a 30-day supplementation with 20-g per day of 72% dark chocolate (DC) or calorically matched white chocolate (WC). Before supplementation, participants underwent two control trials for assessments (PRE1, PRE2) of resting energy expenditure (REE) and exercise energy expenditure (EEE). Following the PRE2 assessment, participants were randomized and supplemented for 30 days, after which they repeated the assessments for REE and EEE. PRE1 and PRE2 REE and EEE were not significantly different within or between groups (REE: PRE1 DC 1215± 170, WC 1127 ± 174, p=0.662; PRE2 DC 1211 ± 174, WC 1145 ± 165 kcal/d, p=0.720; EEE: PRE1 DC 3.67 ± 0.72, WC 3.40 ± 0.81, p=0.665; PRE2 DC 3.41 ± 0.88, WC 3.39 ± 0.73kcal/min, p=0.373). Post-supplementation REE was significantly increased by 3.2% in the DC group (Pre-Post change: DC 38.6 ± 49, WC -15 ± 31.2 kcal per day, p =0.039, Cohen's d= 0.724 [95% CI: 0.078, 1.513]). These results indicate that DC supplementation in postmenopausal women was associated with a significant 3.2% increase in REE with no significant influence on EEE.

Accumulating evidence suggest that imbalanced macronutrient composition would increase the risk of chronic diseases. However, previous studies that predominantly focused on individual macronutrients often failed to thoroughly elucidate this complex association.

This study aimed to comprehensively analyze the relationship between macronutrient clusters and all-cause mortality.

The study included 26,615 adults aged 20-75 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. A three-dimensional cube method was employed to categorize clusters of macronutrients intake. The association between dietary macronutrient clusters and all-cause mortality was investigated using Cox proportional hazards modeling and restricted cubic spline (RCS) analysis.

Over a weighted median follow-up duration of 7.58 years, 3,998 deaths were recorded. After adjusting for potential confounders, compared with the reference Cluster Pm:Fm:Cmh, 4 specific Clusters were associated with reduced all-cause mortality: Cluster Pm:Fm:Cm (HR: 0.79, 95 % CI: 0.67-0.92), Cluster Pm:Fmh:Cml (HR: 0.76, 95 % CI: 0.61-0.95), Cluster Pm:Fmh:Cm (HR: 0.86, 95 % CI: 0.75-0.97), and Cluster Pl:Fm:Cmh (HR: 0.73, 95 % CI: 0.60-0.89). Three-node RCS analysis revealed non-linear relationships between carbohydrate within Cluster Pm:Fm:Cm and protein within Cluster Pl:Fm:Cmh and overall mortality. Subgroup and sensitivity analyses corroborated the robustness of these associations across different age, gender, and energy intake levels.

This study employed a three-dimensional cube approach to categorize the human macronutrients intake into 24 clusters. Cluster Pm:Fm:Cm, Clusters Pm:Fmh:Cml, Cluster Pm:Fmh:Cm, and Cluster Pl:Fm:Cmh exhibited a lower mortality risk. Different clusters of macronutrients could be a precondition in nutrition intervene strategy.

Chronic disease has become an increasing burden in Indonesia, increasing the importance of treatment adherence to control the disease prognosis. Therefore, we aim to determine the prevalence and characteristics of nonadherence in Indonesian chronic disease population.

We identified 11,408 adult subjects with chronic diseases from the fifth Indonesian Family Life Survey. We defined treatment nonadherence as the outcome variable and characteristics related to the World Health Organization Multidimensional Adherence Model as exposure variables. We used descriptive and multivariable analyses to analyze factors related to treatment nonadherence.

We identified that 57% (95% CI 56.1-57.9) of chronic disease patients were nonadherent to their treatment. Treatment nonadherence was notable in subjects with liver disease (61.8%), tuberculosis (59.8%), digestive diseases (57.9%), other lung diseases (56.8%), psychiatric diseases (51.6%), asthma (51.2%), and hypertension (50%). Treatment nonadherence was associated with socioeconomic-related factors of being aged 15-65 years, living in rural areas, having history of formal education, and having a household size of 2-6 people. Furthermore, in patient- and condition-related factors, positive perceptions of their health condition, missing 0-7 days of their regular activity in the last month, being ex- and non-smokers, having no depression symptoms, and having only one chronic disease were associated with treatment nonadherence.

Treatment nonadherence for chronic diseases in Indonesia was found to be prevalent. Further consideration of characteristics associated with treatment nonadherence should be given to ensure optimal control of chronic diseases.

The United States healthcare system grapples with a staggering estimated waste of $935 billion, with pricing failure contributing a substantial $240.5 billion. This paper explores an innovative solution to combat rapidly escalating healthcare costs by proposing measures that would complement the mandated disclosure of healthcare prices. The Centers for Medicare and Medicaid Services (CMS) introduced a significant rule for hospital pricing, effective January 1, 2021, aiming to enhance transparency and empower patients to make value-based decisions. However, this rule has faced criticisms on various policy grounds which this examination delves into. To address these concerns and enhance the effectiveness of price transparency, this paper suggests complementary and/or alternative strategies and solutions while also examining the engagement of enrollees in price transparency tools.

Isothiocyanates (ITCs), found in edible plants such as cruciferous vegetables, are a group of reactive organo-sulfur phytochemicals produced by the hydrolysis of precursors known as glucosinolates. ITCs have been studied extensively both in vivo and in vitro to define their therapeutic potential for the treatment of chronic health conditions. Therapeutically, they have shown an intrinsic ability to inhibit oxidative and inflammatory phenotypes to support enhanced health. This review summarizes the current evidence supporting the observation that the antioxidant and anti-inflammatory activities of ITCs temper the pathogenic effects of a group of reactive metabolites called advanced glycation end products (AGEs). AGE exposure has significantly increased across the lifespan due to health risk factors that include dietary intake, a sedentary lifestyle, and comorbid conditions. By contributing to a chronic cycle of inflammatory stress through the aberrant activation of the transmembrane receptor for AGE (RAGE), increased AGE bioavailability is associated with chronic disease onset, progression, and severity. This review debates the potential molecular mechanisms by which ITCs may inhibit AGE bioavailability to reduce RAGE-mediated pro-oxidant and pro-inflammatory phenotypes. Bringing to light the molecular impact that ITCs may have on AGE biogenesis may stimulate novel intervention strategies for reversing or preventing the impact of lifestyle factors on chronic disease risk.

Climate change poses significant threats to the environment, biodiversity, and socioeconomic stability worldwide. Its impact on human health, particularly within healthcare systems, is growing in concern. Nurses, as front-line healthcare workers, play a crucial role in addressing climate-related health risks. However, there is a gap in understanding nursing perspectives on climate change and its implications for patient health outcomes.

To synthesize empirical evidence on the association between climate change and patient health outcomes from a nursing perspective.

A mixed-methods systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in January 2024 in six scientific databases including CINAHL, PubMed, Scopus, ProQuest, Web of Science, and OVID Nursing. Studies focusing on climate change and patient health outcomes from a nursing perspective were included. Data extraction, quality appraisal, and synthesis were performed systematically.

The systematic review included 18 studies of a mainly quantitative nature. Three main themes emerged as follows: Climate Healthcare Interplay; Future Nurses as Agents of Change; and Navigating Sustainability Challenges in Nursing. These themes highlighted nurses' awareness of the interrelation between climate and health, the need for environmental education in nursing, and the challenges that hinder sustainable nursing practices.

This review underscores the importance of integrating climate change topics into nursing education and fostering organizational support for sustainable nursing practices. Addressing these challenges is essential for nurses to mitigate the health risks posed by climate change effectively.

Chronic disease is a condition that is susceptible to deterioration both physically, psychologically and socially, so protective measures are needed to control this vulnerability, namely by flourishing. This research is aimed at identifying biological, psychological and social factors that influence the proliferation of chronic health.

This research was carried out in five stages by identifying questions according to PCC and searching for qualitative, quantitative and mixed method studies published from 2010 to 2024 that measured the flourishing of various chronic health conditions. The search strategy used the word flourishing and several appropriate terms on Sciencedirect, IEEE Xplore, Emerald, Taylor & Francis, and Oxford Academics as well as Google Scholar as gray literature. 1,550 studies were found from 6 databases and the final selection results found 19 studies to be analyzed. Two reviewers performed data extraction based on the protocol and underwent quality assessment. Results reporting is categorized based on biological, psychological, social and demographic factors that can influence flourishing.

There are biological, psychological and social factors that can influence the proliferation of chronic health, each of which influences the health condition of a person with a chronic health condition.

This study aimed to assess the perceptions towards chronic disease self-management and its program among patients with chronic diseases.

A cross-sectional study using pre-validated questionnaire was conducted among patients with chronic diseases at outpatient pharmacy in a hospital in Penang, Malaysia from April to June 2021.

Of 270 patients participated in this study, 87.8% were interested in chronic disease self-management. Nonetheless, they faced common barriers including time constraint (71.1%), no health monitoring devices (44.1%) and poor health knowledge (43.0%). More than half of the patients expressed that having a better knowledge of the disease and its treatment (64.1%), getting supportive guidance from healthcare providers (59.6%) and having monitoring devices (58.1%) were the top three facilitators to self-management. The patients preferred chronic disease self-management programs that (a) discuss the topic of motivation (b) are available both as mobile applications and hands-on training, (c) individual session, (d) range between 1 and 5 sessions with a duration of 1 to 2 h/session, (e) occurring on monthly basis, (f) conducted by doctor or healthcare professionals and (g) fully sponsored by government or at affordable fee.

The findings serve as pre-requisite step in future design and development of chronic disease self-management program, targeting the patients' needs and preferences.

Health information systems (HISs) should provide accessible and high-quality information to patients. However, the challenge lies in understanding patients' trust preferences for health information. This study explores how different information sources (e.g., online platforms, interpersonal sources) are trusted under varying health conditions, focusing on symptom intensity and disease type.

Using a 2 × 2 × 4 between-subject design, 243 participants from a US college were presented with vignettes of acute or chronic diseases with varying symptom intensities and information sources. Participants rated their trust levels, including both cognitive and behavioral trust, in the health information and recommendations provided by one of the information sources, which was randomly assigned. Logistic regression and ANOVA were employed for the statistical analysis.

The analysis results revealed that trust is generally higher for interpersonal sources like doctors and family/friends compared to online sources like WebMD and Wikipedia when patients are making health decisions. Doctors are the most trusted source during health-related decision making. However, there are no significant differences in cognitive trust among interpersonal sources or among online sources. Furthermore, symptom intensity and disease type did not significantly alter trust levels across various information sources. These findings suggest that people prefer professional medical advice regardless of their health conditions.

The study highlights the need for HIS to incorporate features that provide "doctor-verified" information and promote interactive engagement to enhance patients' trust in information source. Additionally, it distinguishes between cognitive and behavioral trust, revealing distinct trust patterns that can inform the strategic development of HIS for varied health conditions. Understanding these trust dynamics can inform the design of effective, patient-centered HIS that better support health education, information seeking, and decision-making.

Polypharmacy-defined as taking numerous medications that may not be clinically necessary-is becoming a significant concern among the older adult population. This study examined the associations between lifestyle behaviors and the number of prescribed medications in older adults (75 years and older) living in the counties of San Bernardino and Riverside.

This study employed a cross-sectional survey to assess lifestyle behaviors and medication use in 611 older adults aged 75 or over. Bivariate correlation and linear regression analyses were used to assess potential relationships between lifestyle behaviors and the number of prescribed medications.

Fruit consumption (P = 0.005), mild physical activity per week (P < .001), and lifestyle index (P = 0.003) had a highly significant inverse association with the number of prescribed medications. Fat consumption had a direct positive relationship with the number of prescribed medications (P = 0.02).

Higher fat intake was directly linked to an increased need for medications, while regular physical activity, a higher fruit intake, and a healthy overall lifestyle were all associated with a lower likelihood of polypharmacy. Future research can explore the mechanisms linking these behaviors with medication usage.

There is limited information on how healthy behaviors and individual health perceptions mediate the relationship between eating behaviors and noncommunicable diseases in adults. This study aimed to evaluate the mediating role of these factors in the relationship between eating behaviors and comorbidity in U.S. adults.

A cross-sectional predictive study using data from 5,247 adults from the Health Information National Trends Survey (HINTS) 5, cycle 3 (2019) was conducted. Structural equation modeling (SEM) was used to assess the mediating effect.

The model showed good fit (χ2/df = 1.22, CFI = 971, TLI = 959, RMSEA = 0.050, SRMR = 0.036). It was found that self-perceived health totally mediated the relationship between eating behaviors and comorbidities (β = - 0.026, p < .001). Additionally, healthy behaviors and self-perceived health together mediated the relationship between eating behaviors and comorbidities (β = - 0.025, p < .001). A direct relationship was also observed between healthy behaviors and comorbidities, mediated by self-perceived health (β = - 0.103, p < .001).

The study concludes that eating behaviors are significantly related to comorbidities through the mediation of healthy behaviors and self-perceived health.

Research indicates that Black communities experienced disproportionately higher numbers of confirmed cases and fatalities throughout the COVID-19 pandemic with Black men experiencing marked reductions in life expectancy. Inequities were further magnified by known COVID-19 such as hypertension, diabetes, obesity, and higher prevalence of cardiovascular disease. The current project aimed to assess the knowledge, attitudes, and behaviors related to COVID-19 among Black men with chronic conditions. Specifically, we sought to determine whether COVID-19-related perspectives and behaviors impacted cross-sectional health outcomes. A national sample of Black men (N = 312) who self-reported at least one chronic disease responded to survey questions about their knowledge, attitude, and preventative behaviors (KAP) related to COVID-19. Analyses suggest that unique latent profiles based on COVID-19-related KAP differentially impacted participants' self-reported health and well-being for those low on KAP items. The discussion includes considerations on viral hygiene interventions, misinformation, stigma, and perceptions of discrimination.

Previous research has outlined evident disparities in the prevalence of chronic conditions among African Americans compared to other groups, with low-income African American men disproportionately affected by almost every disorder. Self-management programs are useful tools for managing chronic disorders beyond the doctor's office. This monograph provides a detailed looking into the current state of the research on low-income African American men with chronic health conditions. An intersectional approach is used to provide a nuanced synthesis of relevant literature. The project outlines the need for programs designed to engage low-income African American men with skills, resources, and tools for managing chronic conditions. Authors argue that improvements to traditional self-management programs can be realized by emphasizing culture, including end-users in the creation of programs, and offering culturally tailored strategies to improve health. Thus, any targeted program must include culturally detailed information about nutrition, exercise, stress, mental health, and leveraging social support.

To describe the prevalence and trends in the use of social media over time and explore whether social media use is related to better self-care efficacy and thus related to better mental health among United States older adults with multimorbidity.

Respondents aged 65 years+ and having 2 or more chronic conditions from the 2017-2020 Health Information National Trends Survey were analyzed (N = 3341) using weighted descriptive and logistic regression analyses.

Overall, 48% (n = 1674) of older adults with multimorbidity used social media and there was a linear trend in use over time, increasing from 41.1% in 2017 to 46.5% in 2018, and then further up to 51.7% in 2019, and 54.0% in 2020. Users were often younger, married/partnered, and non-Hispanic White with high education and income. Social media use was associated with better self-care efficacy that was further related to better mental health, indicating a significant mediation effect of self-care efficacy in the relationship between social media use and mental health.

Although older adults with multimorbidity are a fast-growing population using social media for health, significant demographic disparities exist. While social media use is promising in improving self-care efficacy and thus mental health, relying on social media for the management of multimorbidity might be potentially harmful to those who are not only affected by multimorbidity but also socially disadvantaged (eg, non-White with lower education).

Great effort is needed to address the demographic disparity and ensure health equity when using social media for patient care.

Telemedicine, as a novel method of health management system, has demonstrated to have a significant impact on health levels. However, a challenge persists in the form of low usage rates and acceptance among older adults in China. There are accumulating evidence that willingness will affect the telemedicine usage among older adults. This study investigates factors influencing older users' trust in adopting telemedicine technology, thereby promoting actual use.

A questionnaire survey was conducted with 400 urban seniors aged 60 and above. Drawing from the Technology Acceptance Model (TAM) and the Decomposed Theory of Planned Behavior (DTPB), the author combines elements such as Perceived Usefulness, Perceived Ease of Use, Subjective Norms, Service Environment, Self-Efficacy, Behavioral Intention to Use, and Usage Behavior. The aim is to explore the interrelationships between these factors.

Perceived Usefulness (PU) and Service Environment (SE) significantly and positively impact Behavioral Intention (BI) to use telemedicine, with Trust (TR) identified as a crucial mediating variable. Enhancing trust can substantially increase older adults' intention to use telemedicine services. Furthermore, the study reveals a significant relationship between older adults' trust in telemedicine and factors such as Perceived Usefulness (PU), Service Environment (SE), Subjective Norms (SR), as well as Emotional Risk (ER) and Cost Risk (CR), the latter two tending to decrease Trust(TR).

This paper constructs and validates a combined model based on TAM and DTPB, comprehensively exploring the potential factors influencing the older adults' intention to use telemedicine. The findings suggest that telemedicine services for older adults should prioritize improving user perception and enhancing trust throughout the service process to effectively increase their willingness to use these services.

Chronic illness affects millions worldwide, rendering the life of those affected complex to manage. Extant research points to the need for effective and supportive care for the successful treatment, yet health care encounters for this population are often filled with negative experiences, ranging from discontinuity of care to disenfranchisement from providers. One such group dedicated to sharing struggles is the NEISVoid (No End In Sight) community on Twitter. Through the use of the hashtag, #NEISVoid, they come together to share what experiences living with chronic illness look like, in vulnerable and potentially unfiltered ways. The present study analyzes the discourse surrounding the hashtag #NEISVoid in tweets published from January 1 2020, until September 1 2022 (N = 450,914 tweets) using the mixed-method analysis of topic model network (ANTMN) approach. We identify and discuss four broad discursive themes: community experiences, symptom management, efficacy solutions, and biomedical health. We analyze this discourse through the chronic care model (CCM) and in light of research on hashtag activism. We discuss practical and theoretical implications for health communicators.

To evaluate age-specific multimorbidity patterns and morbidity burden on mortality and healthcare expenditure across age groups.

Retrospective observational study between January 1, 2009 to December 31, 2017 using electronic health records in Hong Kong: Individuals were stratified by age (< 50, 50-64, 65-79, ≥ 80), and sub-classified by number of morbidities (0, 1, 2, 3, ≥ 4) out of 21 common chronic conditions. Clustering analyses were conducted to identify specific patterns of multimorbidity. Association between the number as well as combinations of morbidities and all-cause mortality and public expenditure was examined.

4,562,832 individuals with a median follow-up of 7 years were included. Mental disorders were the top morbidities among young individuals, while cardiovascular diseases were prevalent in the elderly. An increased number of morbidities was associated with a greater relative risk for mortality and medical expenditure, and this relationship was stronger among younger patients. Compared to individuals in the same age group without morbidity, the hazard ratios (HR; 95% CI) of all-cause mortality in patients aged < 50 and ≥ 80 with two comorbidities 3.81 (3.60-4.03) and 1.38 (1.36-1.40), respectively, which increased to 14.22 (9.87-20.47) and 2.20 (2.13-2.26), respectively, as the number of morbidities increased to ≥ 4. The stroke-hypertension cluster was shown to be associated with the highest HR of mortality 2.48 (2.43-2.53) among all identified clusters arising from the clustering analysis.

Given the stronger association between multimorbidity and all-cause mortality and greater opportunity costs in younger populations, prevention and management of early-onset multimorbidity are warranted. (248 words).

With the trend towards ageing population globally, the salutogenic model can be integrated in interventions for pre-ageing and older adults to better support healthy ageing. However, there is limited research examining the salutogenic model's pathway amongst pre-ageing and older adults. Hence, this study aims to investigate pathways of the salutogenic model amongst pre-ageing and older adults with chronic diseases. Two hundred and eight pre-ageing and older adults were recruited from 11 Senior Activity Centres in Singapore. Data was collected using a self-reported questionnaire and analysed using path analyses. The indirect pathway from Subjective Cognitive Complaints to self-care abilities via sense of coherence and health practices were significant. Participants with higher sense of coherence may have increased capacities to execute more complex forms of self-care. Future interventions integrating the salutogenic model could enhance pre-ageing and older adults' self-care abilities to cope with chronic diseases and contribute to healthy ageing.

Purpose: Benzodiazepines are the mainstay treatment in Alcohol Withdrawal Syndrome (AWS), though they have the potential for abuse and cognitive side effects. Non-benzodiazepines are of growing interest for treatment of AWS; however, the prevalence of non-benzodiazepine use remains unknown. The purpose of this study is to evaluate the prevalence and predictors of non-benzodiazepine use for AWS in the Emergency Department (ED). Methods: A cross-sectional, retrospective study utilizing data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) spanning the years 2014-2020 investigated patients presenting to the ED with AWS. The primary outcome of this study is the prevalence of patients with AWS who received non-benzodiazepine treatment during their ED visit. The secondary outcome was the identification of predictor variables for non-benzodiazepine use. A multivariate logistic regression with a backward elimination approach was employed to identify predictor variables. Results: A total of 2,300 unweighted ED visits included over the study years. When weighted, this represented over 15.2 million ED visits. Across the study period, 3.1% (95% CI, 1.6-6.1%) of patients received non-benzodiazepines. Positive predictors of non-benzodiazepine use included the year 2020 compared to 2014 (OR 6.32, 95% CI, 1.39-28.73) and comorbid depression (OR 4.13, 95% CI, 1.38-12.36). Negative predictors of non-benzodiazepine use included ages 18-40 compared to ages 41-64 (OR 0.34, 95% CI, 0.13-0.91), nursing home residence compared to private residence (OR 0.02, 95% CI, 0.001-0.80), and the South compared to the Midwest region of the United States (OR 0.19, 95% CI, 0.07- 0.51). Conclusion: This study found that non-benzodiazepine use, despite being less common, is becoming more prevalent. Further research is needed to determine the optimal dosing and duration of non-benzodiazepines for AWS. Understanding the factors influencing the prescription patterns of non-benzodiazepines can contribute to informed decision-making and improve the management of AWS.

Background: Community pharmacists are often the most accessible member of the healthcare team to many patients and can play a key role in managing their chronic conditions, such as diabetes or heart disease, through enhanced pharmacy services. Despite their accessibility, pharmacy services are often underutilized due, in part, to a lack of adequate reimbursement models that comprehensively encapsulate all elements of those pharmacy services. While routine documentation of services does collect certain qualitative data, they do not always indicate the nuance of the full scope of services with resulting robust impact and value of those services for the patient and healthcare system. Objective: To develop and pilot an online reporting tool for pharmacist documentation of high impact patient intervention "stories" that includes the nuances of care provision processes in outpatient pharmacy settings that promote positive outcomes. Methods: An online Patient Stories Reporting Tool (PRST) was developed to allow outpatient pharmacists to document details on distinct direct patient care encounters, or "stories", that they felt showcased their value. Documentation through PSRT included limited quantitative data and qualitative data with a focus on a free response narrative for the "story". In a pilot, the PSRT was distributed to 18 pharmacists across 16 practice sites from one partnering pharmacy organization. Qualitative data, the focus of the included analysis, was collected, assessed by project team members, and organized by intervention types. Results: Forty-seven stories involving 17 pharmacists across 13 practice sites from August 2021 to March 2023 were reported. Three types of key intervention stories were identified including General Patient Education (7 stories), Medication Optimization (20 stories), and Cost Reduction (20 stories). Given the nature and scope of this initial pilot, one story for each of the three most prevalent intervention types was identified as exemplifying the types of stories the tool can collect and are subsequently discussed in detail. Conclusions: The three selected stories help to characterize the services pharmacists provide, the critical components of pharmacist-patient interactions, and the value of sharing these stories utilizing tools such as the PSRT. Through these stories, the PSRT also begins to record the nuances of pharmacist interventions and the impact they can make in a patient's healthcare journey. Potential applications of the tool are multivarious including supporting improvements in the perception of pharmacists' roles on the healthcare team and justifying expansion of reimbursement models.

Obesity remains one of the largest health problems in the world, arising from the excess storage of triglycerides (TAGs). However, the full complement of genes that are important for regulating TAG storage is not known. The Glut1 gene encodes a Drosophila glucose transporter that has been identified as a potential obesity gene through genetic screening. Yet, the tissue-specific metabolic functions of Glut1 are not fully understood. Here, we characterized the role of Glut1 in the fly brain by decreasing neuronal Glut1 levels with RNAi and measuring glycogen and TAGs. Glut1RNAi flies had decreased TAG and glycogen levels, suggesting a nonautonomous role of Glut1 in the fly brain to regulate nutrient storage. A group of hormones that regulate metabolism and are expressed in the fly brain are Drosophila insulin-like peptides (Ilps) 2, 3, and 5. Interestingly, we observed blunted Ilp3 and Ilp5 expression in neuronal Glut1RNAi flies, suggesting Glut1 functions in insulin-producing neurons (IPCs) to regulate whole-organism TAG and glycogen storage. Consistent with this hypothesis, we also saw fewer TAGs and glycogens and decreased expression of Ilp3 and Ilp5 in flies with IPC-specific Glut1RNAi. Together, these data suggest Glut1 functions as a nutrient sensor in IPCs, controlling TAG and glycogen storage and regulating systemic energy homeostasis.

Disease trajectories have become increasingly relevant within the context of an aging population and the rising prevalence of chronic illnesses. Understanding the temporal progression of diseases is crucial for enhancing patient care, preventive measures, and effective management.

The objective of this study is to propose and validate a novel methodology for trajectory impact analysis and interactive visualization of disease trajectories over a cohort of 71,849 patients.

This article introduces an innovative comprehensive approach for analysis and interactive visualization of disease trajectories. First, Risk Increase (RI) index is defined that assesses the impact of the initial disease diagnosis on the development of subsequent illnesses. Secondly, visual graphics methods are used to represent cohort trajectories, ensuring a clear and semantically rich presentation that facilitates easy data interpretation.

The proposed approach is demonstrated over the disease trajectories of a cohort comprising 71,849 patients from Tolosaldea, Spain. The study finds several clinically relevant trajectories in this cohort, such as that after suffering a cerebral ischemic stroke, the probability of suffering dementia increases 10.77 times. The clinical relevance of the study outcomes have been assessed by an in-depth analysis conducted by expert clinicians. The identified disease trajectories are in agreement with the latest advancements in the field.

The proposed approach for trajectory impact analysis and interactive visualization offers valuable graphs for the comprehensive study of disease trajectories for improved clinical decision-making. The simplicity and interpretability of our methods make them valuable approach for healthcare professionals.

Background: Diabetes is among the most prevalent and costly disease states to treat. Many self-insured employers offer employee wellness programs to decrease healthcare expenditures for chronic illnesses, such as diabetes. Existing literature demonstrates that pharmacists can positively impact treatment of patients with diabetes and assist in lowering costs of care, but no current literature examines pharmacist intervention within an employee wellness program over a prolonged period of time. Objectives: To quantify the hemoglobin A1c (HbA1c) lowering achieved through participation in a pharmacist-led diabetes coaching program within a self-insured company. Methods: A retrospective chart review was conducted at a self-insured grocery store chain in the Kansas City area with an employee wellness program called Start Now. Patients who enrolled in the Start Now Program for Diabetes Care (SN-DM) between July 1, 2008 and July 1, 2021 with at least two documented HbA1c measurements were included in the analysis. Results: A total of 355 charts were included in the analysis. The average HbA1c reduction observed in program patients was 0.61% (P < .001). At baseline, 40% of program patients were considered to have controlled diabetes (A1c <7%) compared with 60% of patients at most recent HbA1c (P < .001). There was no correlation between HbA1c lowering and number of pharmacist coaching visits; however, greater HbA1c lowering was observed in patients with a higher baseline HbA1c. Conclusion: Patients who participated in the SN-DM program achieved a significant decrease in mean HbA1c. More patients were considered controlled at last or most recent HbA1c according to the American Diabetes Association guidelines.

To examine the longitudinal relationship between edentulism, nutritional intake, and the progress of multimorbidity among older Americans.

We used data from the Health and Retirement Study (2006-2018), a longitudinal survey of older Americans that has collected data biennially since 1992. Edentulism was assessed in 2006 while nutritional intake was assessed in 2013. Multimorbidity was indicated by five self-reported chronic conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Individuals with two or more conditions at baseline were excluded from the analysis. Nutritional intake was calculated by summing 10 nutrients (protein, vitamins C, D, B12 and E, calcium, zinc, polyunsaturated fatty acids, folate, and ß-carotene). Structural equation modelling (SEM) was used to examine the nutritional pathway between edentulism (2006) and the increase in multimorbidity from 2006 to 2018.

The number of individuals included in the analysis was 3463. The incidence of multimorbidity between 2006 and 2018 was 24.07%, while the percentage of edentate participants in 2006 was 16.42%. The mean total nutrition in 2013 was 4.50 (4.43, 4.55). The SEM analysis showed that edentulism was negatively associated with nutritional intake {estimate -0.15 (95%CI: -0.30, -0.01)}. A negative association was found between total nutrition and multimorbidity {estimate -0.008 (95%CI: -0.01, -0.002)}. Age, wealth, and smoking were included in the analysis and had statistically significant associations with multimorbidity.

The analysis demonstrated a longitudinal association between edentulism, nutritional intake, and the progress of multimorbidity.

For centuries, plant seed extracts have been widely used and valued for their benefits. They have been used in food, perfumes, aromatherapy, and traditional medicine. These natural products are renowned for their therapeutic properties and are commonly used in medicinal treatments. Their significant pharmacological profiles provide an excellent hallmark for the prevention or treatment of various diseases. In this study, we comprehensively evaluated the biological and pharmacological properties of nutmeg seeds and explored their efficacy in treating various illnesses.

Published articles in databases including Google Scholar, PubMed, Elsevier, Scopus, ScienceDirect, and Wiley, were analyzed using keywords related to nutmeg seed. The searched keywords were chemical compounds, antioxidants, anti-inflammatory, antibacterial, antifungal, antiviral, antidiabetic, anticancer properties, and their protective mechanisms in cardiovascular and Alzheimer's diseases.

Nutmeg seeds have been reported to have potent antimicrobial properties against a wide range of various bacteria and fungi, thus showing potential for combating microbial infections and promoting overall health. Furthermore, nutmeg extract effectively reduces oxidative stress and inflammation by improving the body's natural antioxidant defense mechanism. Nutmeg affected lipid peroxidation, reduced lipid oxidation, reduced low-density lipoprotein (LDL), and increased phospholipid and cholesterol excretion. In addition, nutmeg extract improves the modulation of cardiac metabolism, accelerates cardiac conductivity and ventricular contractility, and prevents cell apoptosis. This study elucidated the psychotropic, narcotic, antidepressant, and anxiogenic effects of nutmeg seeds and their potential as a pharmaceutical medicine. Notably, despite its sedative and toxic properties, nutmeg ingestion alone did not cause death or life-threatening effects within the dosage range of 20-80 g powder. However, chemical analysis of nutmeg extracts identified over 50 compounds, including flavonoids, alkaloids, and polyphenolic compounds, which exhibit antioxidant properties and can be used as phytomedicines. Moreover, the exceptional pharmacokinetics and bioavailability of nutmeg have been found different for different administration routes, yet, more clinical trials are still needed.

Understanding the chemical composition and pharmacological properties of nutmeg holds promise for novel drug discovery and therapeutic advancements. Nutmeg seed offers therapeutic and novel drug prospects that can revolutionize medicine. By delving into their pharmacological properties, we can uncover the vast potential possibilities of this natural wonder.

Anatomy has been integral to medical and health education for centuries, it has also had a significant role in wider public life, as an educational resource, a link to their health, and also as a darker deterrent. Historically, public engagement in anatomy is hallmarked by public dissections of convicted criminals across the globe. Artists, specifically non-medical men, such as Leonardo da Vinci, are reported to have participated in public dissection. Dissection would later rekindle public interest in anatomy as graverobbing led to the reform and regulation of anatomy in many countries. In recent years, there has been growing interest from the public in learning more about their bodies as health and well-being become of paramount importance, particularly following the COVID-19 pandemic. Anatomy sits in a prime position to direct and instigate conversations around health, well-being, and body image. Every human on earth possesses a perfect resource to look at and learn about. Models, art-based anatomical activities, and crafts provide active learning opportunities for the wider public around anatomy. Most recently, apps, games, and extended reality provide novel and insightful learning opportunities for the public relating to the body. Finally, training and resources must also be made available from institutions and professional bodies to anatomists to enable them to deliver engagement in an already congested and educationally heavy schedule. This resurgence of interest in anatomical public engagement sees anatomy re-enter the public spotlight, with more appropriate resources and educational settings to offer engagement with the aim of benefiting the public.

Rural populations experience a number of disparities that place them at increased risk of morbidity and mortality related to chronic disease, including lower health literacy and greater distance to medical care. Community-based free healthcare education can offer targeted preventive care to these vulnerable populations; however, limited quantitative research exists measuring their impact, specifically on health literacy and likelihood for behavior change. To investigate this, a student-led health education clinic was held in January 2023 in the rural community of Lykens, Pennsylvania by the Student-run and Collaborative Outreach Program for Health Equity (SCOPE). Fifty-five pre- and post-clinic surveys using Likert-style questions measured the knowledge and likelihood of behavioral change for several preventive health topics, including hypertension, diabetes mellitus, cancer screenings, childhood vaccinations, skin cancer, mental health, addiction, and nutrition. From pre- to post-clinic, there was a significant increase in knowledge of hypertension (p = 0.023) and diabetes (p = 0.014), likelihood of attending cancer screenings (p = 0.038), and confidence in identifying cancerous moles (p = < 0.001). There was a non-significant increase in understanding of mental health and nutrition, and no change in understanding of addiction or childhood vaccinations. It is likely that the level of interaction in education provided and relevance of information to participants contributed to effective uptake of information. The results demonstrate an immediate impact on health literacy and likelihood of behavioral change for several important preventive health topics, and advocate for the use of student-run healthcare interventions in addressing the prevalence of chronic disease in rural communities.

The digital health field is experiencing substantial growth due to its potential for sustained and longitudinal deployment. In turn, this may drive improved monitoring and intervention as catalysts for behavioral change compared to traditional point-of-care practices. In particular, the increase in incidence of population health challenges such as diabetes, heart disease, fatty liver disease, and other disorders coupled with rising healthcare costs have emphasized the importance of exploring technical, economics, and implementation considerations, among others in the decentralization of health and healthcare innovations. Both healthy individuals and patients stand to benefit from continued technical advances and studies in these domains. To address these points, this study reports a N-of-1 study comprised of sustained regimens of intermittent fasting, fitness (strength and cardiovascular training), and high protein, low carbohydrate diet and parallel monitoring. These regimens were paired with serial blood ketone, blood glucose (wearable and finger stick) and blood pressure readings, as well as body weight measurements using a collection of devices. Collectively this suite of platforms and approaches were used to monitor metabolic switching from glucose to ketones as energy sources-a process associated with potential cardio- and neuroprotective functions. In addition to longitudinal biomarker dynamics, this work discusses user perspectives on the potential role of harnessing digital devices to these dynamics as potential gamification factors, as well as considerations for the role of biomarker monitoring in health regimen development, user stratification, and potentially informing downstream population-scale studies to address metabolic disease, healthy aging and longevity, among other indications.

Advanced Care at Home is a Mayo Clinic hospital-at-home (HaH) program that provides hospital-level care for patients. The study examines patient- and community-level factors that influence health outcomes. The authors performed a retrospective study using patient data from July 2020 to December 2022. The study includes 3 Mayo Clinic centers and community-level data from the Agency for Healthcare Research and Quality. The authors conducted binary logistic regression analyses to examine the relationship among the independent variables (patient- and community-level characteristics) and dependent variables (30-day readmission, mortality, and escalation of care back to the brick-and-mortar hospital). The study examined 1433 patients; 53% were men, 90.58% were White, and 68.2% were married. The mortality rate was 2.8%, 30-day readmission was 11.4%, and escalation back to brick-and-mortar hospitals was 8.7%. At the patient level, older age and male gender were significant predictors of 30-day mortality (P-value <0.05), older age was a significant predictor of 30-day readmission (P-value <0.05), and severity of illness was a significant predictor for readmission, mortality, and escalation back to the brick-and-mortar hospital (P-value <0.01). Patients with COVID-19 were less likely to experience readmission, mortality, or escalations (P-value <0.05). At the community level, the Gini Index and internet access were significant predictors of mortality (P-value <0.05). Race and ethnicity did not significantly predict adverse outcomes (P-value >0.05). This study showed promise in equitable treatment of diverse patient populations. The authors discuss and address health equity issues to approximate the vision of inclusive HaH delivery.

Vitamin D plays a critical role in bone health, affecting bone mineral density and fracture healing. Insufficient serum vitamin D levels are associated with increased fracture rates. Despite guidelines advocating vitamin D supplementation, little is known about the prescription rates after fragility fractures. This study aims to characterize vitamin D prescription rates after three common fragility fractures in patients older than 50 years and explore potential factors influencing prescription rates.

The study used the PearlDiver Database, identifying patients older than 50 years with hip fractures, spinal compression fractures, or distal radius fractures between 2010 and 2020. Patient demographics, comorbidities, and vitamin D prescription rates were analyzed. Statistical methods included chi-square analysis and univariate and multivariable analyses.

A total of 3,214,294 patients with fragility fractures were included. Vitamin D prescriptions increased from 2.50% to nearly 6% for all fracture types from 2010 to 2020. Regional variations existed, with the Midwest having the highest prescription rate (4.25%) and the West the lowest (3.31%). Patients with comorbidities such as diabetes, tobacco use, obesity, female sex, age older than 60 years, and osteoporosis were more likely to receive vitamin D prescriptions.

Despite a notable increase in vitamin D prescriptions after fragility fractures, the absolute rates remain low. Patient comorbidities influenced prescription rates, perhaps indicating growing awareness of the link between vitamin D deficiency and these conditions. However, individuals older than 60 years, a high-risk group, were markedly less likely to receive prescriptions, possibly because of practice variations and concerns about polypharmacy. Educational initiatives and revised guidelines may have improved vitamin D prescription rates after fragility fractures. However, there is a need to raise awareness about the importance of vitamin D for bone health, particularly in older adults, and additional study variations in prescription practices. These findings emphasize the importance of enhancing post-fracture care to reduce morbidity and mortality associated with fragility fractures.

III.

To assess the impact of a virtual medication adherence training (VMAT) program on students' perceived confidence and perceived competency in delivering medication adherence services via telehealth.

This pilot pre-/post-observational study consisted of 2 subsequent sections: (1) 4 asynchronous self-study modules via Canvas (Instructure, Inc.) learning management system, and (2) 2 live application-based sessions involving virtual and telephonic standardized patients. A pre-/post-survey was given to first-, second-, and third-year Doctor of Pharmacy students to assess perceived confidence and perceived competence. Participants completed a 5-question multiple-choice quiz before and after each module to assess knowledge.

Students' overall perceived confidence and perceived competency significantly increased upon completing VMAT. Knowledge in each module assessment also significantly improved. During the assessment of performance throughout the live sessions, most participants lost points when resolving issues within the interaction, addressing the need for patient follow-up, and assessing patient knowledge of medication adherence.

This novel VMAT suggests that this or similar programs would be beneficial to improve pharmacy students' perceived confidence, perceived competence, and knowledge in delivering virtual medication adherence services in the telehealth setting. The incorporation of such training within the didactic curriculum of doctoral pharmacy programs should be considered to improve patient care skills for future medication experts.

Implementing experiential learning strategies in a concept-based curriculum offers a transformative opportunity for students to gain a patient's perspective when living with a chronic condition. This article discusses an experiential learning activity that engages learners in an immersive way as they learn the concepts of adherence and self-management in a chronic disease-focused nursing course.

Diabetes mellitus is the third most prevalent chronic metabolic disorder and a significant contributor to disability and impaired quality of life globally. Diabetes self-management coaching is an emerging empowerment strategy for individuals with type 2 diabetes, enabling them to achieve their health and wellness goals. The current study aims to determine the feasibility of a diabetes self-management coaching program and its preliminary effectiveness on the clinical and psychosocial outcomes in the Ethiopian primary healthcare context.

The study will employ a mixed-method feasibility randomized controlled trial design. Forty individuals with type 2 diabetes will be randomly allocated to treatment and control groups using block randomization. The primary feasibility outcomes include acceptability, eligibility, recruitment, and participant retention rates, which will be computed using descriptive analysis. The secondary outcomes are self-efficacy, self-care activity, quality of life, and glycated hemoglobin A1c. For normally distributed continuous variables, the mean difference within and between the groups will be determined by paired sample Student t-test and independent sample Student t-test, respectively. Non-parametric tests such as the Mann-Whitney U test, the Wilcoxon signed rank test, and the Friedman analysis of variance test will determine the median difference for variables that violated the normality assumption. A repeated measure analysis of variance will be considered to estimate the variance between the baseline, post-intervention, and post-follow-up measurements. A sample of 10 volunteers in the treatment group will participate in the qualitative interview to explore their experience with the diabetes self-management coaching program and overall feasibility. The study will follow a qualitative content analysis approach to analyze the qualitative data. Qualitative and quantitative findings will be integrated using a joint display technique.

Evidence reveals diabetes self-management coaching programs effectively improve HbA1c, self-efficacy, self-care activity, and quality of life. This study will determine the feasibility of a future large-scale randomized controlled trial on diabetes self-management coaching. The study will also provide evidence on the preliminary outcomes and contribute to improving the diabetes self-management experience and quality of life of individuals with type 2 diabetes.

The trial was registered online at ClinicalTrials.gov on 12/04/2022 and received a unique registration number, NCT05336019, and the URL of the registry is https://beta.

gov/study/NCT05336019 .

Reaching, enrolling, and retaining participants in lengthy lifestyle change interventions for weight loss is a major challenge. The objective of our meta-analysis was to investigate whether lifestyle interventions addressing nutrition and physical activity lasting 6 months or less are effective for weight loss.

We searched for peer-reviewed studies on lifestyle change interventions of 6 months or less published from 2012 through 2023. Studies were screened based on inclusion criteria, including randomized controlled trials (RCTs) for adults with overweight or obesity. We used a random-effects model to pool the mean difference in weight loss between intervention and control groups. We also performed subgroup analyses by intervention length and control type.

Fourteen RCTs were identified and included in our review. Half had interventions lasting less than 13 weeks, and half lasted from 13 to 26 weeks. Seven were delivered remotely, 4 were delivered in person, and 3 used combined methods. The pooled mean difference in weight change was -2.59 kg (95% CI, -3.47 to -1.72). The pooled mean difference measured at the end of the intervention was -2.70 kg (95% CI, -3.69 to -1.71) among interventions lasting less than 13 weeks and -2.40 kg (95% CI, -4.44 to -0.37) among interventions of 13 to 26 weeks.

Short-term multicomponent interventions involving physical activity and nutrition can achieve weight loss for adults with overweight or obesity. Offering short-term interventions as alternatives to long-term ones may reach people who otherwise would be unwilling or unable to enroll in or complete longer programs.

With the accelerating process of population aging, the comorbidity of chronic disease (CCD) has become a major public health problem that threatens the health of older adults.

This study aimed to assess whether CCD is associated with basic activities of daily living (BADL) and explore the factors influencing BADL in older adults.

A cross-sectional community health survey with stratified random sampling among older residents (≥60 years old) was conducted in 2022. A questionnaire was used to collect information on BADL, chronic diseases, and other relevant aspects. Propensity score matching (PSM) was used to match the older adults with and without CCD. Univariate and multivariate logistic regression analyses were used to explore the factors influencing BADL. PSM was used to match participants with single-chronic disease (SCD) and CCD.

Among the 47,720 participants, those with CCD showed a higher prevalence of BADL disability (13.07%) than those with no CCD (6.33%) and SCD (7.39%). After adjusting for potential confounders with PSM, 6,513 pairs of cases with and without CCD were matched. The univariate analysis found that the older adults with CCD had a significantly higher prevalence of BADL disability (13.07%, 851 of 6,513) than those without CCD (9.83%, 640 of 6,513, P < 0.05). The multivariate logistic regression analysis revealed that CCD was a risk factor for BADL in older adults [OR = 1.496, 95% CI: 1.393-1.750, P < 0.001]. In addition, age, educational level, alcohol intake, social interaction, annual physical examination, retirement benefits, depression, weekly amount of exercise, and years of exercise were related to BADL disability (P < 0.05). PSM matching was performed on participants with CCD and SCD and showed that the older adults with CCD had a significantly higher prevalence of BADL disability (13.07%, 851 of 6,513) than those with SCD (11.39%, 742 of 6,513, P < 0.05).

The older adults with CCD are at a higher risk of BADL disability than their counterparts with no CCD or SCD. Therefore, we advocate paying attention to and taking measures to improve the health and quality of life of these individuals.