Health and Medicine

Jensen, Afton; Claunch, Kelsie; Verdeja, Marco; Dungan, Matthew; Anderson, Shellie; Clayton, Colter K.; Goates, Michael, Thacker, Evan (Brigham Young University)
Faculty Advisor: Thacker, Evan (Life Sciences, Public Health)

The purpose of this paper is to provide a systematic review of lay perspectives on the meaning of successful aging from older adults across multiple cultures and countries. Furthermore, this article allows for a discussion of the complexity of older adults' perspectives on successful aging and how successful aging may be defined differently across cultures and countries. We conducted a systematic literature review to identify, summarize, and evaluate peer-reviewed studies of qualitative data on lay perspectives of older adults. This review included studies on elderly populations published from 2010 to 2017 that addressed older adults' lay perspectives on successful aging. Such studies involved primary research performed in the United States, Germany, Singapore, Lebanon, Mexico, Canada, and New Zealand. The key concepts that emerged from older adult responses across all studies included physical health, cognitive health, social engagement, attitude/coping, independence/security, and spirituality. The overall emerging themes from our data suggest that older adults were not as concerned with physical health as biomedical previous research of successful aging often suggest. Rather, older adults focused on maintaining positive attitudes in order to cope with life changes, valuing social engagement and contribution as more essential to successful aging. Respondents from Western Europe valued keeping positive attitudes about death and focusing on gratitude instead of worries. Additionally, respondents from the United States and Mexico placed importance on pursuing activities and interests and having strong involvement with family and friends respectively. Noting differences, respondents from the Middle East, Asia, and Oceania Region, as opposed to respondents from North America, moreso prioritized the absence of chronic disease and comfort in one's own environment over keeping active. By providing a more comprehensive organizational framework of older adults' qualitative responses to successful aging, we better understand what successful aging means across cultures.

Preece, J Caleb; Seibold, Tanner; Hutchison, Cortland (Brigham Young University)
Faculty Advisor: Feland, J. Brent (Life Sciences, Exercise Science)

BACKGROUND: The recent development of shear-wave elastography (SWE) allows for the quantification of muscle elasticity/stiffness without complex biopsy or dynamometry. To date SWE information is available in younger subjects (typically <30 yrs). Variables such as temperature, joint position, ultrasound probe position and pressure can affect the SWE measurement.
PURPOSE: The purpose of this study was to determine the reliability of SWE measurements of both the medial and lateral heads of the gastrocnemius muscle using 3 different trained ultrasound users.
METHODS: Data was collected from 118 volunteers (participants in the Huntsman World Senior Games) in St. George, Utah, 2019. Subjects (62 males: mean age = 68.9 ± 7.8 yrs, Ht = 177.4 ± 8.1 cm, Wt= 85.4±20 kg; 54 females: mean age = 66.9 ± 8.5 yrs, Ht = 164.4 ± 7.2 cm, Wt= 69.8±18 kg) signed an approved consent form and then lay prone on a treatment table for 3 repeated ultrasonic measurement of SWE of both heads of the gastrocnemius using all three trained research assistants.
ANALYSIS: The three SWE measurements were analyzed using SPSS ver25 for medial and lateral gastrocnemius separately using the reliability analysis function and calculating a two-way mixed model of Intraclass Correlation Coefficient (ICC).
RESULTS & CONCLUSION: Overall, the measurements of SWE were very reliable with both the lateral gastrocnemius (ICC = .985) and the medial gastrocnemius (ICC = .991). Based on our experience in learning SWE measurements there is a significant learning curve to probe positioning and pressure as well as waiting for a stable elastography signal on the ultrasound screen. The high ICC values for these repeated measurements demonstrate that SWE measurement of the gastrocnemius can be reliable and repeatable. These results may not apply to other muscles since size and depth of muscle can also affect SWE signaling.

Cromar, Zachary J.; Findlay, Matthew; Turner, Elizabeth; Mills, Ammon (Utah Valley University)
Faculty Advisor: Gazdik-Stofer, Michaela (College of Science - Utah Valley University, Biology); Sylvester, Steven (College of Humanities and Social Sciences - Utah Valley University, Political Science)

The World Health Organization has included vaccine hesitancy in the top ten threats to global health in 2019. Studies done in the United States have shown that the Moral Foundations Theory (MFT) can be used to identify why individuals are more vaccine-hesitant (VH) than others. Counterintuitively, the dichotomous moral foundations (MF) of care vs. harm, traditionally used in pro-vaccine messaging interventions, or fairness vs. cheating, were not found to be the foundations on which VH parents based their decision not to follow the CDC recommended vaccination schedule. It was discovered that the purity vs. degradation and liberty vs. oppression foundations are more important to VH individuals than all other foundations. Highly VH individuals are twice as likely to emphasize purity and liberty. Concerningly, in 2018, Utah ranked in the bottom ten states for child vaccination rates in 11 of the 19 vaccines reported by the Utah Department of Health. We plan on testing a broader messaging intervention than the current, traditional vaccine messages. Our messaging interventions will emphasize the MFs of liberty vs. oppression and purity vs. degradation to see if they will be more effective than our more traditional messaging intervention emphasizing care vs. harm, or an unrelated control message not related to vaccines. We hypothesize that messages emphasizing the purity and liberty foundations will resonate better with the VH and decrease their vaccine-hesitancy relative to the other groups. If our data supports that the MFs of liberty vs. oppression and purity vs. degradation significantly decrease vaccine-hesitancy than current general vaccine education messaging interventions should be broadened to include these MFs. However, if results do not demonstrate that the liberty vs. oppression MFs are more effective at decreasing vaccine hesitancy, then more research should be performed on the subject.

Morgan Howard, Corinna Trujillo Tanner, Boyd Tanner, Brandon Thatcher, Janelle Macintosh (Brigham Young University)
Faculty Advisor: Trujillo Tanner, Corinna (Nursing, Nursing)

Purpose/Aims: The purpose of this Review of Literature is to present the most current and accurate information about e-cigarette use, or vaping, with recommendations for nursing practice.

Rationale/Conceptual Basis/Background: According to the CDC, to date over 1300 individuals have developed severe lung injury, associated with vaping, including 216 fatalities. Most of these cases involved young people in their teens or twenties. There are concerns that marketing for vaping specifically targets young people and leads potential users to consider the practice relatively safe. On the contrary, vaping is associated with several serious health risks, including lipoid pneumonia, acute respiratory distress syndrome and popcorn lung. Little is known about the effects of the 60+ compounds identified in vaping aerosol, which is inhaled directly into the lungs. Nurses are often the first point of contact for patients in primary care and urgent/emergent settings. Nurses provide valuable patient education, health assessment, and referral. It is important for nurses to have access to the latest information about this developing problem.

Methods: We conducted a review of literature. We reviewed and summarized information from the Food and Drug administration, Centers for Disease Control, American Medical Association, American Academy of Pediatrics, and other reputable sources. All information reviewed had been published within the last six months. Research questions which guided this review sought to identify important considerations for nursing assessment, and nursing interventions.

Findings/Clinical Implications:

Nursing Assessment: An important part of nursing assessment should include documentation of a patient's history of vaping. When a patient presents with respiratory symptoms and has a history of vaping, a detailed vaping history covering the previous 90 days should be obtained. When acute lung injury, caused by vaping is identified, it must be reported to local and state health departments, per the new CDC guidelines.

Nursing interventions should include patient education as follows: 98.7% of "vape juice" assayed by the FDA contained the addictive substance nicotine (even if labeled "nicotine free") Nicotine is highly addictive and damages developing brain tissue in fetuses, infants, children and teens Inhaled "second hand" vape aerosol is dangerous for pregnant women, infants, children and those with lung disease The inhaled solution is not "water vapor" but rather an aerosol created by an electric heating element within the vaping device The inhaled solution contains up to 60 + chemicals including heavy metals

There is no established standard for vaping safety

Flavorings in vape juice, although considered safe for ingestion, have not been approved for inhalation and are not known to be safe

Additional information and recommendations will be forthcoming as our understanding of the risks associated with vaping is rapidly evolving.

Wankier, Zakary; Sinclair, Sarina PhD; Drew, Alex PhD; Taylor, Carolyn MS; Kubiak, Eric MD; Agarwal, Jayant MD (University of Utah)
Faculty Advisor: Sinclair, Sarina (School of Medicine, Orthopaedics)

Introduction:

Osseointegration (�OI�) technology is the direct skeletal attachment of a prosthetic limb to bone using an intramedullary stem. For OI to be effective and secure, bone in-growth and remodeling around the implant must be achieved. Physicians need an effective way to measure bone remodeling in order to make informed decisions on treatments. This work describes methodology that was developed that utilizes computed tomography (CT) imaging as a tool for analyzing bone remodeling around an OI implant.

Method:

Subjects implanted with a new Percutaneous Osseointegrated Prosthesis (POP) had CTs taken of their residual femur at 6 and 52-weeks post-op. The CT images were used to segment and create three-dimensional models of the femur.

Following segmentation, models were aligned to a common world coordinate system. STLs of the aligned medullary cavity and femur volume were entered into custom Matlab code to calculate cortical and medullary morphology measurements. Morphology data from 6 and 52-week scans were compared in order to determine if bone remodeling around the POP implant could be detected.

Results:

Comparing data from post-operative visits suggests that important indicators of bone remodeling around the device could be detected. One year after implantation of the POP device the medullary parameters had minimal % differences (-1.5 and 2.2) compared to 6-weeks, validating that consistent alignment was achieved between scans from different time points. Cortical area, perimeter, and thickness around the POP implant showed positive percent changes at 12-months of 19.44%, 4.04% and 14.36% respectively. Increases in cortex morphology values indicate bone remodeling around the implant, with largest increases observed at the distal end for each parameter.

Discussion:

This pilot study utilized CT imaging as a tool for quickly and accurately analyzing bone remodeling around a new osseointegrated device. Additional work will further validate and optimize these methods for clinical use.

This study described an investigational device, limited by federal law to investigational use. No long-term data exists about its performance.

Trumble, Tanner; Jensen, Francine (Utah Valley University)
Faculty Advisor: Jensen, Robert (Utah Valley University, Nursing)

Background: Individuals who experience homelessness lack the necessary components needed receive end of life care (EOL). However, due to personal and structural barriers such as cost of care, lack of insurance, addiction, and many who experience mental health and intellectual disabilities, homeless individuals are unable to receive palliative or hospice care. Because homeless individuals lack the necessary components of basic living such as food, water and shelter, their quality of life is significantly lower than that of the general population, and this affects their EOL experiences.

Purpose: To explore the factors that affect the homeless population and the barriers they face when accessing health care, including their needs at the EOL, and to provide recommendations for better EOL care.

Methods: A focused literature review was performed using the databases PubMed, Google Scholar and Science Direct using the keywords homeless, end of life, and palliative care covering the years 1985 to 2018.

Findings: Homeless individuals want to experience a "good death". Unfortunately, homeless individuals who seek medical treatment feel deterred due to unfair treatment and belittlement from previous health care experiences and the social stigma surrounding homelessness. This can delay their treatment of chronic or acute conditions and lead to long-term health consequences. One effort to aid in EOL care for homeless individuals is the Social Model Hospice, which provides holistic EOL care in home like setting. Social model hospice overcomes barriers to lack of insurance, social support and a location where EOL care can be delivered for homeless individuals.

Significance: Many barriers are limiting medical care for the homeless that should be available to them at the EOL. It is evident that healthcare providers need to be more aware of the needs of this population to help improve and provide the EOL care homeless individuals deserve.

Bergen, Makenna; Meier, Amanda; Thomas, Victoria; Banna, Jinan; Cluskey, Mary; Stokes, Nathan; Richards, Rickelle (Brigham Young University)
Faculty Advisor: Richards, Rickelle (Life Sciences; Nutrition, Dietetics, and Food Science); Stokes, Nathan (Life Sciences; Nutrition, Dietetics, and Food Science); Banna, Jinan (Tropical Agriculture and Human Resources (University of Hawaii at Manoa), Department of Human Nutrition, Food, and Animal Sciences)

Background: Food insecurity among college students has been reported to be as high as 59%. Most research related to this phenomenon has used quantitative approaches. The purpose of this study was to gain a deeper understanding of college students' perceptions of their own food security using qualitative methodology.
Methods: Researchers interviewed 57 college students at three universities across the western United States. A random sample of transcripts were independently coded in NVivo to determine interrater reliability. Kappa statistics ranged from 0.44-0.99 (food insecure) and from 0.73-0.99 (food secure), indicating moderate to almost perfect agreement. Percent agreement ranged from 92-100% (food insecure) and from 97-100% (food secure). Researchers then divided transcripts for final coding and overarching themes, including differences between food secure and food insecure students under each theme, were discussed.
Results: Three themes emerged to help explain drivers of food insecurity in college students: 1) transition from pre-college life to college life; 2) students' management of finances; and 3) methods and barriers to obtaining food. Differences were identified between food secure and food insecure students. Food insecure students prioritized other living expenses over food and used various strategies when funds were low: purchasing lowest cost campus meal plans, stretching food budget, buying cheaper groceries, and skipping meals. In regards to eating away-from-home, food insecure students prioritized eating at home, using discounts, or waiting to get paid before eating out. Both food secure and food insecure students reported positive aspects of using food assistance programs but believed stigma and embarrassment would deter students from using these programs. A few food insecure students expressed confusion about qualifying for these programs.
Conclusions: This study helps us better understand the context surrounding food insecurity in college students. This understanding could lead to broader solutions to helping college students become more food secure.

Kunzelman, Jacqueline; Gabor, Rachel; Scrobotovici, Monica; Blades, Natalie; Longstreth, WT; Heckbert, Susan; Psaty, Bruce; Arnold, Alice; Fitzpatrick, Annette; Llewellyn, David; Kuzma, Elzbieta; Kamel, Hooman; Dhamoon, Mandip; Chaudhry, Sarwat; Dodson, John; Hedges, Dawson; Gale, Shawn; Erickson, Lance; Brown, Bruce; Thacker, Evan (Brigham Young University)
Faculty Advisor: Thacker, Evan (Life Sciences, Public Health)

OBJECTIVE: We investigated two hypotheses: First, incident CHD, defined as myocardial infarction or definite angina, leads to faster long-term cognitive decline. Second, among those with CHD, treatment with CABG surgery or PCI leads to slower long-term cognitive decline.
METHODS: The Cardiovascular Health Study is a cohort of US adults aged 65+. Global cognitive ability was assessed annually up to 9 times from 1990 to 1998 with the 100-point Modified Mini-Mental State Examination (3MS). We estimated trajectories of 3MS scores in the absence of stroke, adjusting for demographics, health behaviors, and comorbidities. For hypothesis 1, we compared 3MS trajectory after incident CHD with 3MS trajectory in the absence of CHD, censoring at first receipt of CABG/PCI. For hypothesis 2, among participants with CHD, we compared 3MS trajectory after first receipt of CABG/PCI with 3MS trajectory without CABG/PCI.
RESULTS: For hypothesis 1, of 4,122 participants, 398 had incident CHD during a mean of 5.9 years of follow-up. Model-predicted 3MS score declined faster after incident CHD, especially for CHD diagnosed at age 80 or later. For example, after incident CHD at age 85, predicted 5-year decline in mean 3MS score through age 90 was 13.9 points (95% CI: 11.0, 16.7) versus 8.9 points (95% CI: 8.1, 9.7) among those without CHD. For hypothesis 2, of 1,183 participants who had prevalent or incident CHD, 118 had their first CABG/PCI during a mean of 4.1 years of follow-up. Model-predicted 3MS score declined faster after first receipt of CABG/PCI.
CONCLUSIONS: Older adults diagnosed with incident CHD had faster average cognitive decline than those without CHD. However, treatment with CABG/PCI did not slow cognitive decline among those with CHD. This finding may be due to adverse effects of CABG/PCI on brain health or CABG/PCI recipients having more severe CHD or more cerebral atherosclerosis.

Hildt, Alyssa; Anderson, Abby; Miles, Leslie; Valentine, Julie (Brigham Young University)
Faculty Advisor: Miles, Leslie (Brigham young University, Nursing); Valentine, Julie (Brigham Young University, Nursing)

Purpose: To describe characteristics that impacted sexual assault (SA) patients' reports of pain and subsequent pain treatment.
Research Question(s) / hypotheses: 1. What percentage of SA patients complaining of pain received any treatment? 2. What associations exist between SA variables and reports of pain and pain treatment?
Methodology: Retrospective chart review (n=1,652) of SA examinations (2017-2018) was conducted in several counties in Utah, representing 80% of the state. 241 variables were entered into SPSS. Approximately 64% of SA cases reported pain. Descriptive statistical analysis of SA patients reporting pain was conducted on the following variables: pain location, pain severity, gender, race, age, relationship to suspect, pre-existing medical conditions, pre-existing mental illness, suspect actions, time between assault and exam, physical injuries, anogenital injuries, and pain treatment (pharmacological and non-pharmacological).
Findings: On a scale of zero to ten, reported pain mean level 5.68 with a median of six. Eight percent of patients who reported pain did not have a documented pain level, signifying an incomplete pain assessment. Three most common pain locations were the genitals (40%), abdomen/pelvis (31%), and head (24%). Those with mental illness, medical problems, or reported history of SA prior to age 14, were more likely to report pain. Despite the prevalence of pain amongst SA patients, a large majority (78%) received no documented pain treatment. However, some patients received the following: 16% NSAIDs or Tylenol; 5% narcotics; and only 0.1% received non-pharmacological treatment.
Implications: All SA patients should be assessed and treated for pain. SA examination forms should include treatment type, including treatment provided by the emergency department. Nurses should take the lead in advocating for pain treatment in SA patients.
Conclusion: This is the largest study of SA patients' pain assessment and treatment and helps create a comprehensive picture to understand patient and variables that impact pain.

Perriton, Kiersten; Eppley, Sydnie; Young, Colleen (Utah Valley University)
Faculty Advisor: Jensen, Francine (Utah Valley University, Nursing)

Purpose: To determine the preparedness of new graduate nurses to practice after completion of nurse residency programs.

Background: New graduate nurses often feel anxious, concerned or ill prepared to practice as nurses on their own. New graduate nurses worry if the residency program has prepared them for their first nursing job sufficiently for them to gain enough confidence and skill to be on their own. Studies on nurse residency programs show that nurses who complete one-year nurse residency programs had remarkable increases in communicating with family, patients and team members, confidence in skills, and ability to prioritize and organize work. There is a need for continued education, such as nurse residency programs and an active interest in new graduate nurses, such as involved mentors or preceptors to help strengthen clinical reasoning and preparedness of new graduate nurses. Stress in new graduate nurses can impede patient safety and can result in the new nurse quitting the position. When new graduates have designated mentors, fit well with unit socialization, and are oriented to multiple areas, it has been identified that it can build their confidence levels and improve retention rates of new graduate nurses. Nurse residency programs need to provide high quality orientation to help them master their careers.

Significance: This research can give insight into whether the implementation of nurse residency programs helps new nurses feel ready to practice on their own. This information may help provide increased safety and quality of care to patients due to new graduate nurses feeling competent and confident to carry out the patient's health care plan. This can help healthcare companies determine if current programs are effective and what needs to be changed. New nurse graduates may gain confidence, practice with increased patient safety, and corporations may retain the new nurses they have just trained.

Salas, Norma; Condie, Kali; Cook, Lauralee (Utah Valley University)
Faculty Advisor: Jensen, Francine (Utah Valley University, Nursing)

Problem Statement:

Depending on the provider a woman has during her delivery, the education, interventions, and care she receives will differ. Variations of care under an obstetrician and gynecologist (OB/GYN) compared to a midwife may produce differing satisfactory results for women experiencing labor and delivery.

Purpose:

The purpose of this research study is to discover if women who have delivered with both an obstetrician/gynecologist and a midwife are more satisfied with their birthing experience under the care of one provider compared to the other.

Research Question:

Are women who have experienced labor and delivery with an OB/GYN and a midwife more satisfied with their birthing experiences from one provider compared to the other?

Background:

In a patient-centered world, it should be up to the provider and expecting mother to choose the modality of delivery they would like, including the place, medical interventions, positioning, and methods of delivery. OB/GYNs and Midwives vary in practices, and implementations during gestation and delivery. Dissatisfaction with labor and delivery is an aspect of the current healthcare industry that needs to be addressed in order to improve patient care. Coxon, Sandall, and Fulop highlight this issue by pointing out that many women feel constrained with their decisions regarding labor and delivery and that delivery opportunities may be limited due to influences from cultural and historical associations as practiced by the provider (2014). Patient satisfaction is also influenced by pressures women in labor and delivery experience in order to accommodate their providers wishes.

Hope to accomplish:

We hope to determine if women's satisfaction during their labor and delivery experiences are higher with either a midwife or an obstetrician/gynecologist, as well as to promote better education and patient autonomy to increase patient experience satisfaction.