Home Survey Research Articles

When Home Hospice Patients Discharge to Nursing Home: A Mixed Method

Background: Hospice care is to provide necessary medical care and support for patients and the families at the end of life (EOL). Hospice care patients typically withdraw from aggressive treatment. Even though home hospice has been shown to improve the quality of care, home hospice patients still revoke the services for various reasons. A little is known about where home hospice patients are being transferred. This study aims to address this gap and explore common reasons for home hospice discharge and placements, where patients being transferred other than home. Methods: Data were retrieved from the 2007 National Home and Hospice Care Survey (NHHCS). NHHCS is one in a series of nationally representative sample surveys of U.S. home health and hospice agencies. Results: Within identified home hospice patients, approximately 82.1% were deceased at discharge, and 846 (18.2%) were discharged for other reasons, including patients being stabilized or improved (30.2%), aggressive treatment (31.8%), moved (e.g., geographically, 13.5%) and others. Patients lived with a spouse were less likely to utilize external resources, like volunteers, thereby more likely to discharge patients to long-term facilities. Discussion: The current study suggest that it is difficult for the family to give all remaining care for their loved ones despite the support and resources for those home hospice patients. The characteristics of those who transferred to nursing facilities from home hospice will be discussed throughout.

Do transitions in and out of homelessness relate to mental health episodes? A longitudinal analysis in an extremely disadvantaged population

This paper studies the association between homelessness and mental health episodes focusing on episodes of depression, anxiety and other conditions (bipolar affective disorder, schizophrenia, and post-traumatic stress disorder). Using panel data from the Australian Journeys Home survey, we investigate the extent to which this association is due to common determinants of homelessness and mental health episodes, or whether there is a causal link between them. The results indicate that episodes of depression increase the probability that a person becomes homeless. This is not the case for other mental health conditions. We find no evidence that becoming homeless causes a person to have a mental health episode. Instead, respondents are less likely to be diagnosed with depression in the 6 months after being precariously housed. Overall, our results indicate that, except for depression, the links between mental health episodes and homelessness are complex and are mostly unlikely to be causal. Using information on service usage, we find suggestive evidence that people use mental health services when they need to but that more coordination with housing services is required to protect them from becoming precariously housed.

Making the Most of Mealtimes (M3): Association Between Relationship-Centered Care Practices, and Number of Staff and Residents at Mealtimes in Canadian Long-Term Care Homes

ObjectivesTo determine if (1) number of staff or residents, when considering home-level factors and presence of family/volunteers, are associated with relationship-centered care practices at mealtimes in general and dementia care units in long-term care (LTC); and (2) the association between number of staff and relationship-centered care is moderated by number of residents and family/volunteers, profit status or chain affiliation. DesignSecondary analysis of the Making the Most of Mealtimes (M3) cross-sectional multisite study. Setting and ParticipantsThirty-two Canadian LTC homes (Alberta, Manitoba, Ontario, and New Brunswick) and 639 residents were recruited. Eighty-two units were included, with 58 being general and 24 being dementia care units. MethodsTrained research coordinators completed the Mealtime Scan (MTS) for LTC at 4 to 6 mealtimes in each unit to determine number of staff, residents, and family or volunteers present. Relationship-centered care was assessed using the Mealtime Relational Care Checklist. The director of care or food services manager completed a home survey describing home sector and chain affiliation. Multivariable analyses were stratified by type of unit. ResultsIn general care units, the number of residents was negatively (P = .009), and number of staff positively (P < .001) associated with relationship-centered care (F9,48 = 5.48, P < .001). For dementia care units, the associations were nonsignificant (F5,18 = 2.74, P = .05). The association between staffing and relationship-centered care was not moderated by any variables in either general or dementia care units. Conclusion and ImplicationsNumber of staff in general care units may increase relationship-centered care at mealtimes in LTC. Number of residents or staff did not significantly affect relationship-centered care in dementia care units, suggesting that other factors such as additional training may better explain relationship-centered care in these units. Mandating minimum staffing and additional training at the federal level should be considered to ensure that staff have the capacity to deliver relationship-centered care at mealtimes, which is considered a best practice.

High Lead Bioavailability of Indoor Dust Contaminated with Paint Lead Species.

House dust and soils can be major sources of lead (Pb) exposure for children. The American Healthy Homes Survey (AHHS) was developed to estimate Pb exposure from house dust and soil, in addition to other potential household contaminants and allergens. We have combined X-ray absorption spectroscopic (XAS) fingerprinting and in vivo mouse relative bioavailability (RBA) measurements for a subset of house dust and residential soils collected in the AHHS, with the primary objective of gaining a better understanding of determinants of house dust Pb bioavailability. Lead speciation was well related to variations in RBA results and revealed that highly bioavailable Pb (hydroxy)carbonate (indicative of Pb-based paint) was the major Pb species present in house dusts. Measured Pb RBA was up to 100% and is likely driven by paint Pb. To our knowledge, this is the first report of in vivo Pb RBA for U.S. house dust contaminated in situ with paint Pb and corroborates results from a previous study that demonstrated high RBA of paint Pb added to soil. We also report a relatively low RBA (23%) in a residential soil where the major Pb species was found to be plumbojarosite, consistent with a previous report that plumbojarosite lowers Pb RBA in soils.

Factors associated with childhood anaemia in Afro-descendant communities in Alagoas, Brazil.

To investigate factors associated with anaemia in preschool children. A home survey was conducted in 2018. Anaemia in children (capillary blood Hb level < 110 g/l) was the outcome, and socio-economic, demographic and health factors of the mother and child were the independent variables. The measure of association was the prevalence ratio, and its 95 % CI was calculated using Poisson's regression with robust variance and hierarchical selection of independent variables. Afro-descendants communities living in the state of Alagoas, northeast Brazil. Children aged 6-59 months and their mothers (n 428 pairs). The prevalence of child anaemia was 38·1 % (95 % CI 33·5, 42·7). The associated factors with child anaemia were male sex, age < 24 months, larger number of residents at home (> 4), relatively taller mothers (highest tertile) and higher z-score of BMI for age, after further adjustment for wealth index, vitamin A supplementation in the past 6 months and clinical visit in the last 30 d. The high prevalence of anaemia observed reveals a relevant public health problem amongst children under five from the quilombola communities of Alagoas. Considering the damage caused to health and multiplicity of risk factors associated with anaemia, the adoption of intersectoral strategies that act on modifiable risk factors and increase vigilance concerning those that are not modifiable becomes urgent.

The Environmental Relative Moldiness Index reveals changes in mold contamination in United States homes over time

The Environmental Relative Moldiness Index (ERMI) is a scale created to compare mold contamination levels in U.S. homes. The ERMI was developed as a result of the Department of Housing and Urban Development’s (HUD) first American Healthy Homes Survey (AHHS I), which sampled 1,096 homes selected to be representative of the U.S. housing stock. In AHHS I, a dust sample from each home was analyzed using quantitative PCR assays (qPCR) for 36 common indoor molds: 26 Group 1 molds, which were associated with water damage in homes and 10 Group 2 molds, which primarily enter the home from the outside environment. In 2019, HUD completed AHHS II by sampling 695 homes. Because lead was banned from paint in 1978, a larger proportion of homes selected for AHHS II had been built before 1978 compared to AHHS I. The 36 ERMI molds were analyzed in AHHS II exactly as in AHHS I. For the 36-ERMI molds, the rates of detection, average concentrations, and geometric means were in significant concordance (p < 0.001) between AHHS I and II, indicating that the ERMI methodology was stable over time. However, the average ERMI value in AHHS II homes was greater than in AHHS I. The reason for the difference was investigated by examining the Group 1 and 2 mold populations. The average summed logs of Group 1 molds were significantly greater in homes built before 1978 than the average for homes built later. Conversely, the average summed logs of Group 2 mold populations were the same in homes built before 1978 and homes built later. Since the summed logs of Group 2 mold is subtracted from the summed logs of Group 1 molds in the ERMI calculation, the average ERMI value was higher in AHHS II homes than AHHS I. In conclusion, by using the ERMI metric, we were able to demonstrate that water damage and mold growth were more likely to occur as homes get older.

Linking Patient Safety Culture to Quality Ratings in the Nursing Home Setting.

There is limited evidence on the associations between patient safety culture and measures of health care quality in nursing homes. This study examines the relationship between scores on the Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey (NH SOPS) and Centers for Medicare and Medicaid Services Nursing Home Five-Star Quality Ratings. Using data from 186 nursing homes, we conducted multiple regression analyses predicting the Five-Star Quality Ratings from the NH SOPS survey measures. Five NH SOPS measures were related to the Overall, Health Inspections, and Quality Five-Star Ratings. Four NH SOPS measures were related to at least two of the four Five-Star Quality Ratings and three SOPS measures were related to one Five-Star Rating. None of the NH SOPS measures were significantly associated with the Staffing Five-Star Rating. Findings generally indicated that stronger patient safety culture is associated with higher quality ratings.

Sustainability of residential environmental interventions and health outcomes in the elderly

BackgroundResearch has documented that housing conditions can negatively impact the health of residents. Asthma has many known indoor environmental triggers including dust, pests, smoke and mold, as evidenced by the 25 million people in the U.S. population who have asthma. The paper describes a follow-up study involving elder adults with asthma who participated in a multifaceted home educational and environmental intervention shown to produce significant health benefits. On average the time between the end of the prior intervention study and the follow-up was 2.3 years. The objective of this study was to evaluate whether improvements in environmental conditions and health outcomes resulting from the original Older Adult Study (OAS, multifaceted educational and environmental interventions) would be maintained or decline over time for these low income seniors with asthma.MethodsHealth assessment included data on respiratory health outcomes included the Saint George’s Respiratory Questionnaire (SGRQ) and Asthma Control Test from the original Older Adult Study (OAS) and this follow-up Older Adult Study (OAFS) along with health care utilization data. Environmental assessments included evaluation of asthma trigger activities (ATAs) and exposures before and after the original healthy homes intervention (questionnaire, home survey) and at this follow-up. Assessments were conducted in English, Khmer and Spanish.ResultsAt assessment in the Older Adult Follow-up Study (OAFS), the older adults maintained some of the health improvements gained during the OAS when compared to the OAS pre-intervention baseline. However, health outcomes declined from the OAS final assessment to the OAFS (only the SGRQ Impact scores were significantly different).ConclusionThese findings suggest that further study with a larger population is needed to determine if the significant health outcome improvements from multifaceted home educational and environmental interventions (OAS) could be more strongly maintained by providing additional follow-up “booster” interventions to this older adult population with asthma.

Trauma symptoms contribute to daily experiential avoidance: Does partner support mitigate risk?

Objective: The present study examined the protective role of partner support in reducing daily experiential avoidance (EA) associated with trauma symptoms in a sample of 154 couples during pregnancy. Background: Although psychological distress during pregnancy may hinder the developing bond between parents and infants after birth, high quality intimate partner support has the potential to enhance psychological wellbeing during pregnancy, particularly in the context of trauma. Specifically, partner support might mitigate the impact of trauma symptoms on maladaptive coping strategies such as EA by enabling individuals to safely encounter their distress. Method: Participants completed a semi-structured clinical interview of support and a PTSD symptom inventory, followed by home surveys of EA over 14 days. We examined growth trajectories of EA over 14 days using latent trajectory modeling within a dyadic framework. Results: Trauma symptom severity was associated with higher levels of EA across the 2 weeks; however, among women, the impact of trauma symptoms on EA was no longer significant when support from a partner was above average quality or higher. Findings also revealed partner effects; to the extent that women reported higher levels of trauma symptoms, their partners had higher levels of EA. Conclusion: Findings highlight the protective role of high quality support from intimate partners and suggest that trauma-related interventions targeting partner support processes, especially those implemented during pregnancy, might enhance recovery and prevent further distress and dysfunction among pregnant women experiencing trauma symptoms.

Digitale Transformation im stationären Altersbereich

HintergrundStationäre Altersinstitutionen durchlaufen derzeit einen digitalen Transformationsprozess, der durch die Orientierung an einer zunehmenden Digitalisierung von Arbeitsprozessen und der institutionellen Infrastruktur gekennzeichnet ist. Doch wie sieht die Vielfalt der eingesetzten technischen Lösungen in den Altersinstitutionen überhaupt aus, und wie wird der digitale Transformationsprozess von den Leitungspersonen der Institutionen bewertet?Material und MethodenDie Befragung erfolgte als standardisierte Onlinebefragung bei stationären Alterseinrichtungen in der gesamten Schweiz. Befragt wurden die jeweiligen Leitungspersonen. Die Stichprobe bildeten 466 Institutionen.ErgebnisseEtablierte Technologien, wie z. B. Fernseher, Kontakt- und Sturzmatten sowie Softwarelösungen im Verwaltungsbereich, werden fast flächendeckend eingesetzt, während Roboter zur Aktivierung der Klientel, Spielkonsolen oder telemedizinische Technologien nur sehr selten verwendet werden. Die befragten Personen sehen in der Anwendung technischer Hilfsmittel eher Vor- als Nachteile. Die größten Hindernisse, die bei der Einführung neuer Technik wahrgenommen werden, sind die damit verbundenen Kosten, fehlende Mitarbeiterkompetenzen und eine nichtvorhandene Infrastruktur. Die multivariate Analyse zeigt, dass der Digitalisierungsgrad in einer Einrichtung nicht nur von deren Größe abhängt, sondern auch von der Technikaffinität der leitenden Mitarbeitenden.DiskussionDer Technologisierungsgrad in Altersinstitutionen ist unterschiedlich hoch, insgesamt aber eher ernüchternd niedrig, hinsichtlich der Verwendung neuer Technologien wie der Robotik oder Telemedizin. Barrieren für die digitale Transformation wurden aus der Befragung herausgearbeitet und diskutiert.

Patient safety culture and obstacles to adverse event reporting in nursing homes.

To investigate patient safety culture and its relationship with obstacles to adverse event reporting in Chinese nursing homes. Reporting obstacles are related to high incidences and unreported rates of adverse events. Patient safety culture is also associated with adverse events. However, the relationship between reporting obstacles and patient safety culture in nursing homes is unclear. A cross-sectional survey was conducted with a random sampling method among 549 staff members in six nursing homes using instruments of the Nursing Home Survey on Patient Safety Culture and the Adverse Event Reporting Obstacle Scale. The Pearson correlation coefficient, independent t tests, ANOVA tests and multivariate regression analysis were used. Patient safety culture in nursing homes was associated with facility ownership (p<.001), facility scale (p<.001), reporting management (p<.001), whether it was an integrated care institution (p=.006), frequency of concern about patient safety (p=.001), occurrence of adverse events in departments (p=.001) and a punitive atmosphere (p=.044). Adverse event reporting obstacles were negatively correlated with patient safety culture (p<.05). An improvement in patient safety culture was associated with a reduction in reporting obstacles in nursing homes. A barrier-free adverse event reporting system should be built to reduce reporting obstacles and create a non-punitive patient safety culture in nursing homes.

Low Cardiovascular Disease Awareness in Chilean Women: Insights from the ESCI Project.

Background:Although cardiovascular disease (CVD) is the leading cause of mortality in Latin American women, limited data exist on CVD perceptions in this population. This study aimed to assess CVD awareness and knowledge of women from Santiago, Chile.Methods:This was a cross-sectional study conducted in women 35 to 70 years old. A multistage probability sampling (stratified by age and socioeconomic level) was used for participant selection. Participants completed a home survey about knowledge of CVD, risk factors, and perceived risk (based on standardized questions from the American Heart Association awareness survey).Results:723 women participated in the study (mean age: 51 ± 9 years; 17.6% with high education level). Only 9.3% of the respondents mentioned CVD as women’s primary health problem, whereas 22.7% and 16.1%, respectively, listed breast cancer and other cancers. When asked to identify the leading cause of women’s death, only 14.4% identified CVD compared to 69.1% who recorded cancer. Older women (≥ 55 years) more likely identified CVD as the main cause of death: (OR 2.9: 95% CI = 1.8–4.5) versus younger women (<55 years). CVD family history was also associated with higher awareness of CVD as the leading cause of death (OR 1.7: 95% IC; p = 1.1–2.6). Instead, women with middle education level were less likely to mention CVD as the main women’s killer.Conclusions:Chilean women from Santiago have a low awareness of CVD as the leading cause of death and do not recognize CVD as their prominent health problem. Efforts should focus on increasing awareness and knowledge about CVD especially in young women.

Addressing the Gap: OT in Hospice Care

Abstract Date Presented 03/27/20 This study addresses a gap in knowledge regarding OT in hospice care. We examined patient profiles and services provided and compared demographics and outcomes for patients with versus without OT in the context of hospice care. We analyzed the de-identified data retrieved from a large national survey: The National Home and Hospice Care Survey (NHHCS) of 2007. Primary Author and Speaker: Emily Mueller Additional Authors and Speakers: Chih-Ying Li

Family relationships and LGB first homelessness in Australia: What do we know and where should we go?

Family conflict is a well-documented causal factor in the international literature on youth homelessness. Less is known about how childhood experiences within family of origin contribute to first homelessness among Australian lesbian, gay, bisexual, transgender and queer (LGBTQ+) young people. In this article, which draws on an analysis of the Australian Journeys Home survey, we argue that homelessness risk among LGB young people is cumulative and stems from multiple childhood disadvantages. LGB respondents were more likely than their heterosexual peers to report leaving home in the early teens. They were also more likely to have experienced conflict, abuse and deprivation in their families of origin, including: the threat of harm from someone within the family home environment; a lack of adequate food and shelter during childhood; high levels of childhood sexual abuse; and early experience of parental divorce. We discuss the implications of these findings for future LGBTQ+ research agendas.

Associations between the Home Environment, Feeding Practices and Children's Intakes of Fruit, Vegetables and Confectionary/Sugar-Sweetened Beverages.

Within the home environment, parents influence their children’s dietary intakes through their parenting and dietary practices, and the foods they make available/accessible. The aim of this cross-sectional study was to examine the associations between home environmental characteristics and children’s dietary intakes. Three hundred and thirty-two children aged three–five years and their parents participated in the study. Home environmental characteristics, including parental control feeding practices, were explored using validated and standardized questionnaires such as the Child Feeding Questionnaire (CFQ), the Physical and Nutritional Home Environment Inventory (PNHEI) and the Healthy Home Survey (HHS). Parent and child food consumption was also measured. Pressure to eat from parents was associated with lower fruit intake in children (OR 0.67, 95% CI 0.47–0.96, p = 0.032). Greater variety of fruit available in the home increased the likelihood of fruit consumption in children (OR 1.35 95% CI 1.09–1.68, p = 0.005). Watching television for ≥1 h per day was associated with a decreased probability of children eating vegetables daily (OR 0.38, 95% CI 0.20–0.72, p = 0.003) and doubled their likelihood of consuming confectionary/sugar-sweetened beverages more than once weekly (OR 2.15, 95% CI 1.06–4.38, p = 0.034). Children whose parents had lower vegetable consumption were 59% less likely to eat vegetables daily. This study demonstrates that modifiable home environmental characteristics are significantly associated with children’s dietary intakes.

Miten kaupungistuminen ja väestön ikääntyminen vaikuttavat vapaa-ajan asumisen suosioon?

Mökkeily on keskeinen osa suomalaista elämäntapaa. Suomen yli puoleen miljoonaan kesämökkiin on infrastruktuureineen sitoutunut huomattava määrä kansallisvarallisuutta ja suomalaisten henkilökohtaista omaisuutta. Mökkeilyn tulevaisuudesta on kuitenkin esitetty huolta. Miten yhteiskunnan suuret trendit, kuten väestön ikääntyminen ja kaupungistuminen, vaikuttavat vapaa-ajan asumiseen? Väheneekö vai lisääntyykö vapaa-ajan asunnoilla vietetty aika? Tässä tutkimuksessa laadittiin vapaa-ajan asumisen skenaario vuodesta 2018 vuoteen 2040. Skenaario pohjautuu Tilastokeskuksen väestöennusteeseen, kaupunki-maaseutuluokitukseen sekä valtakunnalliseen vapaa-ajan asumisen kyselyyn. Skenaarion mukaan kaupungistuminen ja ikääntyminen lisäävät jonkin verran vapaa-ajan asuntojen käyttöä tulevaisuudessa. Kaupungistuminen lisää mökkeilyä enemmän kuin ikääntyminen. Kaupunkialueilla asuvat viettävät merkittävästi enemmän aikaa vapaa-ajan asunnoilla kuin maaseudulla asuvat. Keskimäärin eniten mökkeilevät 65–74-vuotiaat sisemmällä kaupunkialueella asuvat. Kaupungistumisen ja ikääntymisen lisäksi myös muut trendit, jotka eivät sisälly skenaarioon, voivat lisätä tai vähentää vapaa-ajan asunnoilla vietettävää aikaa. Tällaisia ovat muun muassa hyväkuntoisen eläkeiän pidentyminen, tulojen ja varallisuuden kasvu, tietoliikenneyhteyksien paraneminen vapaa-ajan asunnoilla, kasvava matkailu ja muut vapaa-ajanviettotavat, pidemmät mökkimatkat ja maahanmuutto.

Validity of Two Questionnaires and Two Prediction Equations for Estimating Total Energy Expenditure in Healthy Adults: A Doubly Labeled Water Study

Abstract Objectives The doubly labeled water (DLW) method is the gold standard for assessing total energy expenditure (TEE), but is costly. Questionnaires and prediction equations for TEE are nearly cost-free but research on their validity is scarce. We evaluated the validity of TEE assessed by two questionnaires and two prediction equations in comparison with TEE assessed by DLW. Based on previous work, we hypothesized that the questionnaires would be valid at a group level, and that the prediction equations would be valid at an individual level. Methods Data from a 10-d observational study in 124 healthy, nonsmoking adults were used (63% F, aged 29.8 ± 12.2 y, BMI 24.5 ± 3.9 kg/m2 (Mean ± SD)). TEE was measured by DLW using a mixed oral 2H218O dose containing 0.15 g 2H218O and 0.07 g of 2H2O per kg body weight. Analysis of urine samples and calculations of TEE were carried out using standard methodology. TEE was estimated from the 7-day Physical Activity Recall (7dPAR; Sallis et al. 1985), the Block Work and Home Survey (BWHS; Block et al. 2009), Dietary Reference Intakes (DRI) equations for estimated energy requirements of adults with normal weight or overweight/obesity (IOM 2005), and the BOD POD air displacement plethysmograph. 7dPAR TEE was estimated by multiplying MET-min/day with resting metabolic rate estimated from DRI basal energy expenditure equations. The BOD POD measured body composition by densitometry and TEE was estimated from fat-free mass and fat mass (Nelson et al. 1992) and an activity factor (WHO 1985). Results TEE values were 2430 ± 535 (DLW), 2375 ± 445 (7dPAR), 2407 ± 750 (BWHS), 2335 ± 388 (DRI), 2134 ± 439 (BOD POD) kcal/d (Mean ± SD), with DRI and BOD POD significantly lower than DLW (P &amp;lt;0.01). Mean ± 2SD limits of agreement (kcal/d) between DLW and 7dPAR (−766, 877) and BWHS (−1420, 1468) were wider than those between DLW and DRI (−630, 822) and BOD POD (−463, 1057). The R2 and SEE of the method associations with DLW ranged from 0.17 to 0.54 and 264 to 688 kcal/d, respectively (all P = 0.000). Conclusions The 7dPAR and BWHS were valid for estimating TEE at a group level. While the DRI and BOD POD equations were more accurate at estimating TEE of individuals, none of the tools are recommended for individual assessment of TEE due to their low R2 and wide Bland-Altman limits of agreement with DLW. Funding Sources NIH R01 DK075862 and Purdue University.

Spatial and Social Determinants of Household Food Environments in Central North Carolina

Abstract Objectives This study explores sociodemographic predictors of household food environments and tests the hypothesis that they are associated with community food environments. Methods Data are from the baseline visit of the Mothers &amp; Others study, an early life obesity prevention trial among 430 African-American mothers in central North Carolina. Healthy Homes Survey (HHS) data assessed household food availability, type and variety. Exploratory factor analysis (EFA) with oblique rotations consolidated 45 HHS variables into household food environment (HFE) types. From data retailer InfoUSA we obtained geocoded data containing all food outlets in the study area to assess proximity and density of food outlets near households. Linear regressions tested associations between maternal and household characteristics and HFE factor scores. Adjusted models tested the association between HFE factor scores, community food environment exposures, and sociodemographic interactions. Results EFA retained four HFE types: Factor 1, the healthiest, contained fresh fruits/vegetables (F/V), Factor 2 contained canned F/V, sweets, and salty snacks, Factor 3 contained frozen F/V, candy and sweetened drinks and Factor 4, the least healthful, contained (diet) soda, candy and sweets. SNAP participation was associated with a 23% (CI: –0.42, –0.04) z-score reduction for Factor 1 only. Each additional education level was associated with a 20% (CI: 0.10, 0.31) and 18% (CI: 0.07, 0.29) z-score increase for Factors 1 and 3, respectively. Each 1-unit increase in household size and maternal age accompanied a 6% (CI: 0.001, 0.11) and 3% (CI: 0.01, 0.05) respective z-score increase for Factor 3 only. Each additional dollar store within a 1-mile radius was associated with a 13.8% (CI: –0.22, –0.06) z-score reduction for Factor 3 while each mile closer to a grocery store accompanied a 12.1% (CI: 0.003, 0.24) z-score increase for Factor 3. Among households not receiving SNAP or WIC benefits, each mile closer to a grocery store accompanied a 27% (CI: 0.05, 0.47) and 30% (CI: 0.04, 0.55) respective z-score increase for Factor 1. Conclusions Healthy food environments are associated with local food outlet access and household characteristics. However, enrollment in nutrition assistance programs strongly modifies this relationship. Funding Sources National Institute of Child Health and Human Development.

Examining NTA performance and potential using fortified and reference house dust as part of EPA's Non-Targeted Analysis Collaborative Trial (ENTACT).

Non-targeted analysis (NTA) methods are being increasingly used to aid in the identification of unknown compounds in the environment, a problem that has challenged environmental chemists for decades. Despite its increased use, quality assurance practices for NTA have not been well established. Furthermore, capabilities and limitations of certain NTA methods have not been thoroughly evaluated. Standard reference material dust (SRM 2585) was used here to evaluate the ability of NTA to identify previously reported compounds, as well as a suite of 365 chemicals that were spiked at various stages of the analytical procedure. Analysis of the unaltered SRM 2585 extracts revealed that several previously reported compounds can be identified by NTA, and that correct identification was dependent on concentration. A manual inspection of unknown features in SRM 2585 revealed the presence of two chlorinated and fluorinated compounds in high abundance, likely precursors to perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS). A retrospective analysis of data from the American Healthy Homes Survey revealed that these compounds were present in 42% of sampled homes. Spiking the dust at various stages of sample preparation revealed losses from extraction, cleanup, and instrumental analysis; the log Kow for individual compounds influenced the overall recovery levels but no pattern could be discerned from the various degrees of interference that the matrix had on the ionization efficiency of the spiked chemicals. Analysis of the matrix-free chemical mixture at low, medium, and high concentrations led to more correct identifications than analysis at one, very high concentration. Varying the spiked amount and identifying reported compounds at known concentrations allowed an estimation of the lower limits of identification (LOIs) for NTA, analogous to limits of detection in targeted analysis. The LOIs were much lower than levels in dust that would be likely to cause bioactivity in humans, indicating that NTA is useful for identifying and monitoring compounds that may be of toxicological concern. Graphical abstract.

Nursing Home Survey on Patient Safety Culture: Cross-cultural Validation Data From Spanish Nursing Homes.

Developing an adequate patient safety culture is a relevant objective for all health care levels. The Nursing Home Survey on Patient Safety Culture (NHSOPS) is a 12-dimension tool assessing safety culture in nursing homes (NH) for elder people. The psychometric properties of its Spanish adaptation are evaluated in this study. Nursing homes with 15 beds or more, located in the Basque Country (North Spain), were invited in the study. All staff types were allowed to participate. Internal consistency was tested with Cronbach's α. Convergent and divergent validity with Spearman's correlations. Two-sample t test was used for known-groups validity. The NHSOPS dimensionality was tested with confirmatory factor analysis (CFA), and its stability in consecutive administrations (test-retest) was explored. Five hundred fifty-three valid baseline and 83 retest replies were received. The data suggest that the NHSOPS can be represented by a 10-factor model. Two items (A6 and A10) had loadings of less than 0.12. The rest survey items obtained loadings of greater than 0.40. Estimated correlations supported the convergent and divergent validity of the survey. Managers and administrators, as well as staff considering their NH to be a safe place for residents, obtained higher NHSOPS scores, suggesting acceptable known-groups validity. On the other hand, test-retest variation was considerable. The current data support a simpler model, similar to that of the Norwegian NHSOPS validation. The stability of the scale should be further assessed in a bigger sample. Test-retest reliability and developing an adequate scoring scheme are issues worth of further study.