Potential Negative Health Outcomes Research Articles

The prevalence of adolescent fatherhood and its associated factors in East African countries

BackgroundIn developing nations, the phenomenon of adolescent fatherhood poses significant challenges, including increased risk of poverty, limited educational opportunities, and potential negative health outcomes for both the young fathers and their children. However, an overwhelming majority of research has concentrated on teenage motherhood. Adolescent fatherhood in poor nations has been the subject of little research. Few public health initiatives address adolescent fatherhood, in contrast to adolescent motherhood. Although there is currently more being done in industrialized nations to recognize adolescent fatherhood in clinical settings and the academic community. Undeveloped nations such as East Africa still have more problems that need to be resolved. Therefore, this study aimed to investigate the prevalence of and factors contributing to adolescent fatherhood in East Africa.MethodsData from the Demographic and Health Surveys (DHS), collected between 2011 and 2022 in 12 East African nations, were used in this analysis. For a weighted sample of 36,316 male adolescents aged 15–24 years, we examined variables, as well as the prevalence of adolescent fatherhood. Univariate and multivariable logistic regression analyses were performed to identify candidate factors and significant explanatory variables associated with the outcome variable. The results are presented using adjusted odds ratios (AORs) at 95% confidence intervals (CIs). P values of ≤ 0.2 and < 0.05 were used to investigate statistically significant factors in the univariate and multivariable logistic regression analyses, respectively.ResultsThe overall prevalence of adolescent fatherhood was 11.15% (95% CI = 10.83,11.48) in East Africa. Age at first sex 20–24 years (AOR = 0.44, 95% CI:0.41,0.48), age–20–24 years old (AOR = 17.03,95% CI = 15.01,19.33), secondary/higher education (AOR = 0.57, 95% CI = 0.49,0.67), poor wealth (AOR = 2.27, 95% CI = 2.05,2.52), middle wealth (AOR = 1.70, 95% CI = 1.51,1.90), employed (AOR = 3.92, 95% CI = 3.40,4.54), utilized modern contraceptives (AOR = 0.75, 95% CI = 0.69,0.81), and female household heads (AOR = 0.43, 95% CI = 0.39,0.48) were associated with adolescent fatherhood.ConclusionsAdolescent fatherhood is more prevalent, in East Africa. These findings highlight the complexity of adolescent fatherhood and suggest that multiple factors, including socio-demographic characteristics and reproductive health behaviors, play a role in determining the likelihood of becoming an adolescent father. Understanding these associations can inform targeted interventions and policies aimed at reducing adolescent fatherhood rates and addressing the specific needs and challenges faced by young fathers in East Africa. Further research and interventions should focus on promoting education, economic opportunities, and access to modern contraceptives, while also addressing gender dynamics and social norms that contribute to adolescent fatherhood in the region.

Are Supplemental Nutrition Assistance Program Restrictions on Sugar-Sweetened Beverages Effective in Reducing Purchase or Consumption? A Systematic Review

The participants in the Supplemental Nutrition Assistance Program (SNAP) consume greater amounts of sugar and sweetened beverages (SSBs) compared to non-eligible individuals, which could result in potential negative health outcomes. This can be attributed to the lack of restrictions on SSB purchases with SNAP benefits. In view of the increasing calls from advocates and policymakers to restrict the purchase of SSBs with SNAP benefits, we performed a systematic review to assess its impact towards SSB purchases and consumption. We searched articles from five databases—Cochrane, EBSCO, SCOPUS, Web of Science, and PubMed—and selected seven studies, four of which were randomized controlled trials (RCTs) and three were simulation modeling studies. All three simulation studies and one RCT reported outcomes in terms of consumption, while the other three RCTs reported outcomes in terms of purchases. All seven studies found that an SSB restriction led to a decrease in SSB consumption or purchases, with six studies reporting significant results. Nonetheless, limitations exist. These include limited studies on this subject, potential workarounds circumventing SSB restrictions, like making purchases using personal cash, potentially differed estimated effects when combined with incentives or other initiatives, and the limited geographical scope among the selected RCTs.

Balancing Time for Health Behaviors: Associations of Time Perspective With Physical Activity and Weight Management in Older Adults.

To examine associations between time perspective and health promotion behaviors of physical activity and weight management. Quantitative cross-sectional. This study is part of the Betula project on aging, memory, and dementia in Northern Sweden. 417 older adults aged between 55 and 85years. Swedish-Zimbardo Time Perspective Inventory; Physical Activity in the past year, past week, and in comparison with others of similar age; Weight Management = Body Mass Index (BMI; kg/m2). After controlling for age, sex, and years of education, hierarchical linear regression indicated a Balanced Time Perspective was significantly associated with more physical activity in the past year (P = .04), the past week (P < .001), and in comparison with others (P < .01). Past Negative time perspective was associated with less physical activity in the past year (P = .03), and in comparison with others (P = .03). Present Fatalistic was associated with less physical activity during the past week (P = .03), and in comparison with others (P = .01). Present Hedonistic was associated with more physical activity the past week (P = .03), and in comparison with others (P = .03). Past Negative was associated with higher BMI (P = .02), and Future Negative were associated with lower BMI (P = .01). Taken collectively, greater positivity and flexibility across time perspectives was associated with more physical activity, whereas negative oriented time perspectives related with less physical activity and poorer weight management. Time perspective can be associated with health behaviors in older adults and have implications for health across the lifespan. Health promotion interventions may target older adults' enjoyment of exercise and weight management in the present, rather than highlight potential negative health outcomes in the future.

Has Zika been forgotten? A qualitative exploration of knowledge gaps, perceived risk and preventive practices in pregnant women in Malaysia

BackgroundAlthough Zika virus infection is rarely reported now, continuous prevention is needed to achieve sustained eradication. This study aimed to explore the knowledge gaps, risk perception and preventive measures against Zika virus infection (ZIKV) in pregnant women in Malaysia.MethodsWe conducted in-depth virtual interviews with pregnant women between February and April 2022. The interviews were recorded and transcribed, and data were analyzed by content analysis.ResultsThe majority of the participants demonstrated a commendable level of awareness regarding the signs and symptoms associated with ZIKV infection. They also exhibited a clear understanding of preventive measures, particularly emphasizing the importance of avoiding mosquito bites to minimize the risk of ZIKV transmission. However, a noteworthy gap in knowledge surfaced as a subset of participants remained uninformed about the potential for sexual transmission of ZIKV, which could lead to congenital ZIKV in pregnant women. Even among women who were cognizant of ZIKV and its potential negative health outcomes, associated with the infection, many of them did not perceive themselves to be at risk, mainly because ZIKV infection is infrequently discussed or heard of, leading to a sense of infections’ rarity. While the adoption of preventive measures such as mosquito bite prevention during pregnancy was a common practice, however, prevention of sexually transmitted infections (STIs) including mosquito-borne diseases such as Zika is low. A minority of women express concerns about the sensitivity surrounding discussions and prevention of STIs within the context of marriage. Most of the participants were supportive of the provision of awareness of ZIKV infection in women during pregnancy and the involvement of men, especially in initiatives aimed at preventing transmission through sexual contact.ConclusionThis study uncovered gaps in both knowledge and practices pertaining ZIKV infection among pregnant women in the aftermath of the ZIKV pandemic. The insights gleaned from our research are valuable for shaping future interventions geared towards preventing the resurgence or facilitating the sustainable eradication of ZIKV.

Pattern of substance use and substance use disorder in adolescent learners at public secondary schools in Gaborone, Botswana.

IntroductionSubstance use amongst adolescents remains a global public health challenge. The potential negative health outcomes of substance use suggest the need to understand the pattern of use and the associated factors among adolescents. This study aimed to describe the prevalence of substance use, SUDs, and PD and the associated factors in adolescent learners at public schools in Gaborone, Botswana.MethodsA cross-sectional study was conducted at 13 public secondary schools in Gaborone among 742 students. Assessment tools included the World Health Organization drug questionnaire, DSM-5 interview for SUD, and the General Health Questionnaire-12.ResultsThe mean age (SD) of the participants was 15.26 (1.57) years, and there were more females (55.5%). Over two-fifths (44.6%) of learners reported psychoactive substance use in the past 12 months, and 31.5% meeting DSM 5 criteria for a SUD. Alcohol was the most used psychoactive substance (25.1%). Male gender (AOR = 1.94; 95% CI: 1.26–2.995), having a friend (AOR = 4.27; 95% CI: 2.68–6.78), or father (AOR = 1.87; 95% CI: 1.14–3.04), who uses substance, and higher levels of PD (AOR = 1.09; 95% CI: 1.03–1.17) remained significantly associated with SUD. Regular participation in religious activities negatively correlated with SUD (AOR = 0.61; 95% CI: 0.38–0.96).ConclusionThe high prevalence of substance use and SUDs among in-school adolescents is concerning. Substance use programs need to include family-focused and religious-based therapy and youth empowerment in developing positive peer relationships. Also, they should be integrated with mental health screening to assess comorbid PD.

Phthalate and bisphenol a exposures during pregnancy: Findings from the National Children's Study

Maternal exposure to phthalates and bisphenol A (BPA) during pregnancy can result in many adverse offspring health outcomes. Exposure to phthalates and BPA can vary depending on consumption of certain foods, some of which may vary by race/ethnicity. This study relates urine phthalate and BPA concentrations to sociodemographic and diet data. Concentrations of bisphenol A (BPA) and 11 phthalate metabolites were measured from spot urine at the third trimester visit of a sample of 485 pregnant women from the National Children's Study Vanguard Study Pilot data from seven U.S. cities. At the same time, food frequency questionnaires (FFQ) using the Diet*Calc software were obtained from 313 (65%) participants to assess dietary behavior. Overall, phthalate metabolites were highest among Hispanic women, particularly mBP, miBP, and mECPP, and these disparities were not explained by diet. Participants who did not attend college had higher concentrations of mBP, mBzP, mEP, and miBP, and lower mCOP. These disparities were also not explained by diet. The causes for these disparities should be further studied to reduce potential negative health outcomes associated with phthalate exposure for children of Hispanic or non-college educated women.

Adolescents’ self-efficacy and digital health literacy: a cross-sectional mixed methods study

BackgroundThe internet and social media are increasingly popular sources of health information for adolescents. Using online health information requires digital health literacy, consisting of literacy, analytical skills and personal capabilities such as self-efficacy. Appraising trustworthiness and relevance of online health information requires critical health literacy to discriminate between sources, critically analyse meaning and relevance, and use information for personal health. Adolescents with poor digital health literacy risk using misinformation, with potential negative health outcomes. We aimed to understand adolescents’ contemporary digital health literacy and compared self-efficacy with capability.MethodsAdolescents (12–17 years) completed an eHEALS self-report digital health literacy measure, a practical search task using a think-aloud protocol and an interview to capture perceived and actual digital health literacy. eHEALS scores were generated using descriptive statistics, search tasks were analysed using an observation checklist and interviews were thematically analysed based on Social Cognitive Theory, focussing on self-efficacy.ResultsTwenty-one participants generally had high self-efficacy using online health information but perceived their digital health literacy to be higher than demonstrated. They accessed online health information unintentionally on social media and intentionally via search engines. They appraised information medium, source and content using general internet searching heuristics taught at school. Information on social media was considered less trustworthy than websites, but participants used similar appraisal strategies for both; some search/appraisal heuristics were insufficiently nuanced for digital health information, sometimes resulting in misplaced trust or diminished self-efficacy. Participants felt anxious or relieved after finding online health information, depending on content, understanding and satisfaction. They did not act on information without parental and/or health professional advice. They rarely discussed findings with health professionals but would welcome discussions and learning how to find and appraise online health information.ConclusionsWhilst adolescents possess many important digital health literacy skills and generally feel self-efficacious in using them, their critical health literacy needs improving. Adolescents desire increased digital health literacy so they can confidently appraise health information they find online and on social media. Co-designed educational interventions with adolescents and health providers are required.

Users of cannabis-only are less likely to accept brief interventions than other substance use profiles in a sample of people living with HIV/AIDS.

Research has shown that people living with HIV/AIDS (PLWHA) engage in increased rates of substance use, which has a number of potential negative health outcomes. Increased legalization of cannabis is likely to further increase the availability and use of cannabis in this population. Efforts have been made to integrate screening and intervention resources as part of an individual's routine healthcare visits. Though brief approaches such as Screening and Brief Intervention (SBIRT) have shown promise in addressing alcohol use, results are mixed in addressing cannabis use. The present study investigated how individuals reporting cannabis use responded to an invitation to engage in a brief negotiated intervention (BNI). PLWHA participated in a self-administered tablet computer-based version of SBIRT. Patients screened as having at-risk, high-risk, or dependent substance use (N = 331) were eligible to receive the BNI. Of these patients, 101 reported cannabis-only use, with or without alcohol. Binary logistic regressions controlling for Alcohol Use Disorders Identification Test and Drug Abuse Screening Test score and demographics, found that cannabis-only use was significantly related to declining the BNI. Cannabis-only engagement predicts lower BNI acceptance rates than other substance use profiles; inappropriate screening tools may be one reason for this discrepancy. Implications and directions for future research are discussed. Findings are relevant in modifying SBIRT for cannabis use. To our knowledge, this is the first work to evaluate acceptance of brief interventions for cannabis as compared to other substances and brief intervention acceptance in a sample of PLWHA.

Measuring perception of mental well-being in patients under isolation precautions: a prospective comparative study

ObjectivesIsolation precautions (IP) are applied to prevent transmission of pathogens in healthcare settings. Potential negative health outcomes experienced by patients have been previously described but results remain conflicting. We aimed...

Potentially toxic elements dynamics in the soil rhizospheric-plant system in the active volcano of Fogo (Cape Verde) and interactions with human health

Volcanic eruptions disturb directly and indirectly the ecosystems. Direct impact occurs on the soil–plant system with an input of new elements and indirect hazard occurs by consumption of these plants. Fogo island (Cape Verde Republic) has an active volcano and the last eruption occurred in 2014–15, expelling large amounts of materials that spread all over the island. Soils and edible plants were collected all over the island. Pollution indexes reveal contamination in all samples, mostly due to Hg and Ni and with moderate contribution of Co, Cr, Cu and Pb. Mercury is the PTE with higher contribution to the non-carcinogenic hazard quotient, both by soil ingestion and inhalation. Carcinogenic risk exceeds the target risk in all samples with the higher contribution of Ni. Transfer factor from soils to plants decreasing order is Mn > As > Zn > Cr > Cu > Cd > Pb > Ni > Co > Hg, being < 1 except for As and Mn (TF > 1 point to a significant accumulation of elements in edible plants). The hazard risk index and targeted hazard quotient shows that potential negative health outcomes can be induced by As, Cr, Cu, and Zn by consumption of edible plants.

A qualitative study about college students’ attitudes, knowledge and perceptions regarding sugar intake

Excessive sugar intake has been associated with multiple health conditions (e.g., higher risk for non-communicable diseases). Hence, health organizations have issued guidelines defining the maximum daily intake of free or added sugars. However, data from several countries suggests that these guidelines are rarely met, particularly by young adults. For example, almost half of Portuguese adolescents and young adults exceed the recommended sugar intake. In this work, we aim to further explore college students’ attitudes, knowledge, and perceptions about sugar intake, as well as about sugar intake guidelines. A thematic analysis on data from five focus groups (N = 40) indicated that participants reported difficulty in the comprehension of added/free sugars definition and sugar intake recommendations. Overall, attitudes toward sugar were ambivalent. Sugar was simultaneously perceived as pleasurable and needed, but also as addictive and harmful. Although aware of the potential negative health outcomes associated with excessive sugar intake, most participants did not perceive being at risk due to their youth, exercise habits, or type of diet. The few concerns expressed were mostly associated with the negative impact of high sugar intake on body image (e.g., weight gain). The main barriers to reducing sugar intake identified were environmental (e.g., time restrictions, food available at the university). Still, participants could identify several individual strategies to effectively regulate sugar intake. By identifying knowledge gaps and sources of bias related to sugar consumption, our findings are useful to inform future interventions aiming to address the problem of high sugar intake among university students.

Are general practitioners willing to deprescribe in oldest-old patients with polypharmacy?

Abstract Managing the growing number of oldest-old patients with multimorbidity and polypharmacy in primary health care poses an increasing public health challenge. Since inappropriate polypharmacy can harm patients’ health, general practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe. This case vignette study evaluates the deprescribing decisions of GPs from 31 countries and compares the factors influencing GPs’ deprescribing decisions. We invited GPs to participate in an online survey, containing a) three cases of increasingly dependent oldest-old multimorbid patients with potentially inappropriate polypharmacy and b) Likert-scale questions assessing the importance of factors influencing deprescribing. We presented each case with and without history of cardiovascular disease (CVD). For each case, we asked whether GPs would deprescribe any medication and, if so, which one(s). We calculated percentages of GPs deprescribing at least one medication in each case, compared cases with/without CVD history and different levels of dependency in activities of daily living, and calculated the percentage of factors rated as important or very important. Of 3175 invited GPs from 31 countries, 53% responded (N = 1’706) with a mean age of 50 years and 60% females. Results are preliminary, but despite some differences across GP characteristics (male/female, age) and across countries, GPs generally showed a high willingness to deprescribe in oldest-old patients (&amp;gt;80 years) with polypharmacy. GPs were more likely to deprescribe in patients with a higher level of dependency, in the absence of history of CVD, and when patients are on statins, proton-pump inhibitors or potentially inappropriate pain medication. Factors GPs rated as important or very important for the deprescribing decision were patients’ quality of life, risks and benefits of medications, patients’ life expectancy, and potential negative health outcomes resulting from deprescribing. Key messages Despite international differences, most GPs report they would deprescribe in older multimorbid patients with polypharmacy. The results will facilitate the development of interventions supporting general practitioners to deprescribe.

The impact of shift work and organisational climate on nurse health: a cross-sectional study

BackgroundThe negative effects of shift work schedules, specifically night and rotating shifts, have been widely reported. However, little is understood whether particular aspects of the organisational environment, related to specific shifts, may influence the negative impact of shift work. This study investigated the variation in organisational climate and health outcomes across shift work schedules (day, night, rotating).MethodsThis cross-sectional study involved nursing staff (n = 108) who were all registered nurses from two Melbourne health services. There were slightly more nursing staff that participated from one health service (n = 56) than the other health service (n = 52). Nursing staff completed a survey on either paper form or online which comprised of: demographic characteristics, organisational climate (work environment scale) and health outcomes (general health questionnaire).ResultsThe study found that organisational climate factors and health outcomes differed across shift types. Rotating shift staff exhibited significantly higher coworker cohesion scores when compared to night staff. Night staff reported significantly greater levels of physical comfort within their work environment than rotating staff. Overall, supervisor support emerged as a significant predictor of health outcomes such as somatic complaints, social dysfunction and overall distress. Task orientation was also shown to significantly predict levels of social dysfunction.ConclusionsFindings suggest that interventions with a focus on enhancing the organisational climate, focused in increasing supervisor support, may mitigate the potential negative health outcomes experienced by shift workers.Trial registrationNot applicable to this study.

Demand for and availability of specialist chemsex services in the UK: A cross-sectional survey of sexual health clinics

Background/introductionChemsex amongst men who have sex with men (MSM) is well documented in major cities within the United Kingdom (UK), but few data from less urban areas exist. We undertook a survey of sexual health clinic (SHC) healthcare workers (HCWs) to explore demand for and availability of chemsex services to understand training needs and inform service planning. MethodsAn online survey was distributed to HCWs in all SHCs across the UK. For English clinics, we explored associations between responses and geo-demographic region using national surveillance data and population statistics. ResultsResponses were received from 56% (150/270) of SHC’s in the UK (89% (133/150) from English clinics). 80% (103/129) of UK clinics reported chemsex consultations and in 50% (65/129) these occurred at least monthly, with no significant difference found when analysed by the geo-demographic characteristics of England (p=0.38). Respondents from most clinics (99% (117/118)) wanted chemsex training, 81 %(103/129) felt there was a local clinical need for a chemsex service and 33% (14/43) had chemsex care-pathways for referrals in place. Discussion/conclusion: Patients reporting chemsex regularly present to SHCs throughout the UK including rural areas. Given the potential negative health outcomes associated with chemsex, there is a need for local, high quality, appropriate services and training to minimise harm.

Where Does Your State Stand on Shackling of Pregnant Incarcerated Women?

Pregnant incarcerated women have been identified as a particularly high-risk group and among the most vulnerable women in the United States. The use of shackling or restraints poses health risks to pregnant women and their fetuses. Currently, only 22 states have legislation prohibiting or limiting the shackling of pregnant women. Here we provide an overview of the potential negative health outcomes that can result from shackling pregnant women, especially during labor and birth, and suggest strategies for nurses who wish to promote optimal health care for incarcerated women and to advocate for anti-shackling legislation in their states.

Assessment of the rates and characteristics of unclaimed prescriptions

ObjectivesThe purpose of this study was to describe the rates of and characteristics associated with unclaimed prescriptions during 3 seasonal months. DesignRetrospective cohort study. SettingThis study was conducted using Kaiser Permanente Colorado administrative data. ParticipantsAll patients who had a prescription prepared at 1 of 28 outpatient pharmacies during the months of November 2014, February 2015, and May 2015 were included. An unclaimed prescription was defined as any prescription medication not dispensed to a patient within 15 days after preparation. Patients with an unclaimed prescription were compared to patients without an unclaimed prescription during the study months. Main outcome measuresThe rates of unclaimed prescriptions, characteristics of patients with and without unclaimed prescriptions, and medication characteristics between unclaimed and claimed prescriptions. ResultsA total of 866,554 prescriptions were prepared during the study months, with 44,836 being unclaimed (5.2%; 95% CI 5.1%-5.2%). Of the 225,510 patients with a prescription prepared during the study months, 30,800 patients (13.7%) had at least 1 unclaimed prescription. Neither the size of the pharmacy nor the season in which the prescription was prepared had a meaningful impact on the unclaimed prescription rate. Miscellaneous (e.g., disinfectants, antidotes, medical devices) and respiratory medication classes had the highest rates of unclaimed prescriptions. Patient characteristics associated with having had an unclaimed prescription included having had a hospice, skilled nursing facility, or long-term care facility stay after the prescription was prepared (odds ratio 2.48 [95% CI 1.91-3.23]) and at least 1 other medication dispensed previously (odds ratio 1.83 [95% CI 1.73-1.94]). ConclusionThe rate of unclaimed prescriptions was relatively low; however, approximately 1 in 8 patients with a prepared prescription had at least 1 unclaimed prescription. Future research is needed to identify effective interventions to reduce unclaimed prescriptions in order to prevent potential negative health outcomes.

Differential effects on adiposity and serum marker of bone formation by post-weaning exposure to methylparaben and butylparaben

Paraben esters and their salts are widely used as preservatives in cosmetics, personal care products, pharmaceuticals, and foods. We and others have reported that parabens promote adipogenesis in vitro. Here, we investigated the effects of post-weaning exposure to parabens (methylparaben and butylparaben) on body weight, white adipose tissue mass, and obesity associated metabolic biomarkers in female obesity-prone C57BL/6J mice fed with a chow diet or a high fat diet. Methylparaben exposure by daily oral gavage (100mg/kg/day) increased adiposity and serum leptin levels compared to the controls when fed the chow diet, but not the high fat diet. In contrast, butylparaben exposure did not induce such effects. Exposure to either paraben induced changes in gene expression related to adipocyte differentiation and lipogenesis in the white adipose tissue (WAT) and the liver, regardless of diet. Moreover, exposure to both parabens under the chow diet significantly decreased serum procollagen type 1 N-terminal propeptide (P1NP) but had no effects on C-terminal telopeptide of type I collagen (CTX-I) levels, suggesting that post-weaning exposure to paraben may negatively affect bone formation, but not bone resorption. Taken together, our results demonstrate that post-weaning exposure to paraben, methylparaben in particular, promotes adipogenesis but suppresses serum marker of bone formation in vivo. Our results add to the growing body of literature indicating potential negative health outcomes associated with paraben exposure. Further study of early life exposure to paraben on the development of fat and bone is warranted.

Research Participation for Bereaved Family Members: Experience and Insights From a Qualitative Study.

Research has highlighted potential negative health outcomes for bereaved family members after loss of a loved one in the ICU and has helped identify areas for intervention. The findings exist because these family members agreed to participate in research studies; but little is known about their experience of research participation. To understand why family members participate in bereavement research and the benefits of participating in such research. Qualitative study using interviews with bereaved family members as well as letters written by bereaved family members. Forty-one ICUs in France. Family members who lost a loved one in the ICU. Thematic analysis was used and was based on 54 narratives, 52 letters, and written annotations on 150 questionnaires. Regarding reasons to participate and benefits of research participation, 6 themes emerged: 1) to say thank you to the ICU team, 2) to help other bereaved family members, 3) to express myself from a distance, 4) to not feel abandoned, 5) to share difficult emotions and to help make meaning of the death, and 6) to receive support and care. Bereavement research is possible after loss of a loved one in the ICU and may even be beneficial for family members. Exploring families' experiences of research participation helps define specific family needs in this setting. After the loss of a loved one in the ICU, bereaved families need opportunities to voice their feelings about their experience in the ICU and to give meaning to the end-of-life process; families also need to feel that they are still cared for. Support for the family may need to be developed after loss of a loved one in the ICU in the form of condolence letters, phone calls, or postintensive care meetings.

Potatoes and Maillard Reaction Products (MRPs): The need for a benefit‐risk approach

During heating, hundreds Maillard reaction products (MRPs) can form in foods that contain reducing sugars and amino nitrogen groups, which provide browning and positive sensory aspects to a food. Recent in vitro and animal evidence suggests many MRPs may contribute to promoting health. However, literature has focused primarily on one MRP – acrylamide ‐ purported to have negative health outcomes. As a consequence, the potentially beneficial attributes of MRPs have been largely neglected. Moreover, traditional approaches to risk assessment of foods have not taken into account nutritional benefits. We performed an analysis of the literature on MRPs and human health to evaluate the breath of evidence. As potatoes have been a primary focus relative to acrylamide, we also evaluated whether potatoes could be utilized as a potential model for a benefit‐risk assessment. Results indicate the evidence from clinical trials is fragmented, with few clear areas specific to health outcomes developed – either positive or negative. In particular, the literature on risks associated with dietary acrylamide is controversial and inconclusive. The literature on potatoes supports an important positive role in the American diet ‐ specifically with respect to fiber and potassium nutriture, two of the four nutrients of concern in the U.S. population. Our findings indicate the need for a benefit‐risk approach to ascertain that decreased consumption of foods like potatoes ‐ based on a single compound ‐ does not lead to unintended consequences of further nutrition inadequacies and other potential negative health outcomes. Sponsored by the Frozen Potato Products Institute.

Testing a Model of Caregiver Satisfaction with Hospice Care in the Cancer Population (S762)

•Identify factors that place a caregiver at risk for dissatisfaction with hospice care and potential negative health outcomes.•Discuss the complex nature of caregiver satisfaction and critique one model of caregiver satisfaction. Caregiver satisfaction with hospice care is a quality measure for hospice organizations and predicts caregiver and patient health, mortality, and resource use. Contributing factors to caregiver satisfaction are poorly understood and tested models of caregiver satisfaction in the literature are scarce. To fill this gap, our aim was to develop and test a model of caregiver satisfaction with hospice care in the cancer population. This retrospective cohort study used national data collected by the National Hospice and Palliative Care Organization (NHPCO) using the Family Evaluation of Hospice Care (FEHC) survey in 2011. We utilized a random sample of 1000 cancer caregivers (70,782 available). Our initial theoretical model posited a relationship between demand (measured by reported patient symptoms) and satisfaction, modified by internal and external caregiver resources. Structural equation modeling was used to test the model and adjustments made to improve model fit. The final model fit the data well (LR=189.08, df=78; RMSEA=0.04; CFI=0.91; SRMR=0.03). Caregiver satisfaction was predicted by demand—higher perception of demand (more patient symptoms) reduces caregiver satisfaction. Patient age, caregiver race, education, relationship to the patient, and length of hospice stay modify this relationship directly—black, non-spousal, and more highly educated caregivers are less satisfied, along with caregivers of younger patients and those with shorter lengths of stay. Patient and caregiver age, caregiver sex, and length of stay influence this relationship by altering caregiver perception of demand. Younger caregiver and patient age, female caregivers, and longer length of stay increases caregiver demand, decreasing satisfaction. Note that length of stay works both for and against satisfaction. Caregiver satisfaction is a complex perception that depends on caregiver and patient characteristics, as well as hospice care received.