Risk For Health Complications Research Articles

Oncologist participation in pilot testing a crowdsourcing platform to build a survivorship care risk model.

e13568 Background: Crowdsourcing as a means of codifying the knowledge of many individuals can be an effective way to build models where data do not exist to inform these models. Risk for health complications during cancer survivorship is one area where there are limited large datasets that track detailed outcomes. While many survivorship care expert groups such as the National Comprehensive Cancer Network (NCCN) and Children’s Oncology Group (COG) Survivorship Guidelines Panels recognize the need for a stratified system of assigning survivorship care, criteria for assigning risk to individuals at the end of active cancer treatment are not well agreed upon. To build a model for risk of health complications during survivorship care, we created an online crowdsourcing platform called Follow-up Interactive Long-Term Expert Ranking (FILTER). With FILTER we invite oncologists from a range of backgrounds to determine which case, among two cases, is higher risk. This process is repeated many times by many oncologists to achieve a consensus rating for risk for each case. The purpose of this preliminary study was to understand the characteristics of oncologists who were willing to participate in pilot testing FILTER and the number of cases they were able to adjudicate. Methods: We released the FILTER application in November 2021 to members of the NCCN Survivorship Guidelines Panel, COG Survivorship Guidelines Panel, and Vanderbilt-Ingram Cancer Center oncologists. Through the registration process, we collected institution and specialty information about each expert to determine whether a diverse range of experts were contributing their experience to the risk model. Results: Out of over 100 oncologists who were invited to participate in pilot testing of FILTER, 29 users have signed up for an account and adjudicated at least one matchup. These experts came from 13 institutions and have adjudicated a total of 1665 matchups generating risk scores for 78 synthetic cases. The median number of matchups adjudicated per expert was 45. There were 15 medical oncologists, 3 radiation oncologists, a surgical oncologist, and 10 pediatric oncologists who participated in pilot testing. Conclusions: We succeeded in recruiting a limited number of experts to date from a diverse range of oncology specialties, institutions, and backgrounds to pilot test FILTER. However, recruitment has been inadequate to meet the needs of the project. We therefore will seek to recruit more oncologists to refine these scores and will use meetings of oncology groups such as ASCO to achieve this goal. With enough adjudications by oncologists, a reliable ranking of cases by risk score will allow us to create a model to inform a survivorship risk calculator. This calculator, which will be made publicly available once finalized and validated, will provide another resource to help triage cancer survivors to appropriate survivorship care needs.

Utilisation de la kétamine chez les patients ambulatoires : que pouvons-nous apprendre des pratiques actuelles ?

Two off-label use of ketamine are framed by recommendations: in intractable pain in palliative situations or in postoperative pain. Ketamine is used in hospital but can also be used outside hospital with dispensations by hospital pharmacy to outpatients. Few data are available on ketamine use outside hospital. In this context, the French Addictovigilance Network has set up a study with hospital pharmacies. This survey assesses ketamine dispensations from 1 January to 30 April 2019, for patients who have an administration of ketamine outside hospital. Sixty-five (65) hospital pharmacies have dispensed ketamine for 553 patients. Ketamine was indicated within non-palliative care in 86% of cases. Most of non-cancer pain were in fibromyalgia (44%) and neuropathic pain (29%). During the 4-month monitoring period, 1352 dispensations were analysed. The frequency of administration is daily in 91% of cases within palliative care whereas it is much more diverse within non-palliative care (33% daily, more than 15 different frequency in fibromyalgia). Within palliative care, ketamine is most administered intravenously or by Patient Controlled Analgesia or syringe pump (78% of cases) whereas in non-palliative care, ketamine is most used subcutaneously (44%), orally (32%) or both subcutaneously and orally (20%). A large number of ampoules could be dispensed (more than 30 ampoules for 10% of dispensations). These data highlighted that recommendation in pain are not respected because most of ketamine is used within non-palliative care context and it should be noted a great heterogeneity of practice. This study underlines the urgency of targeted and clear information on certain off-label uses of ketamine for which no robust clinical studies are available and for which the risk of health complications like psychiatric (addiction), urologic and hepatologic complications is proven.

\u2018It\u2019s like Going to the Regular Class but without Being there\u2019: A Qualitative Analysis of Older people\u2019s Experiences of Exercise in the Home during Covid-19 Lockdown in England

It is expected that the Covid-19 lockdown will have increased physical inactivity with negative impacts for older people, who are at greater risk of health complications from the virus. This paper draws on customer evaluation questionnaire of a Pilates class aimed at people aged over 50 years old, which transitioned from a studio setting to online classes via Zoom at the start of the lockdown in England. The paper aims to (i) evaluate the shift of exercise services to online and (ii) examine how engagement with online services has influenced people’s reaction to Covid-19 and unprecedented confinement to their homes. Our analysis shows that experiences of exercise in the home are dependent on prior exercise engagement, particularly a sense of progress and competency in exercise movements, trust in the instructor and socio-economic privileges that enable participants to love and appreciate their homes. This paper argues that online classes have had positive impact on participants’ ability to cope with lockdown: routine, structure and being seen by others all proved important well-being aspects.

Ceramide Biomarkers Predictive of Cardiovascular Disease Risk Increase in Healthy Older Adults After Bed Rest.

Acute bed rest places older adults at risk for health complications by disrupting homeostasis in many organ systems, including the cardiovascular system. Circulating ceramides are emerging biomarkers predictive of cardiovascular and metabolic health and have recently been shown to be sensitive indices of cardiovascular (CV) risk. Therefore, the purpose of this study was to characterize the time course of changes in circulating ceramides in healthy younger and older adults after 5 days of bed rest and to determine whether short-term bed rest alters CV-related circulating ceramides. We hypothesized that circulating ceramides predictive of poor cardiometabolic outcomes would increase following 5 days of bed rest. Thirty-five healthy younger and older men and women (young: n = 13, old: n = 22) underwent 5 days of controlled bed rest. Fasting blood samples collected daily during the course of bed rest were used to measure circulating ceramides, lipoproteins, adiponectin, and fibroblast growth factor 21 (FGF21) levels. The primary findings were that circulating ceramides decreased while ceramide ratios and the cardiac event risk test 1 score were increased primarily in older adults, and these findings were independent of changes in circulating lipoprotein levels. Additionally, we found that changes in circulating adiponectin, FGF21 and the 6-minute walk test (6MW) inversely correlated with CV-related circulating ceramides after bed rest. The results of this study highlight the sensitivity of circulating ceramides to detect potential CV dysfunction that may occur with acute physical disuse in aging.

Low energy availability in group of Polish female soccer players

The most important element of a well-balanced diet is a proper energetic value. Energy deficiencies are often observed in athletes, especially women. Energy deficiencies can lead to low energy availability which can cause serious health problems and affect exercise capacities. There is, therefore, a risk of health complications and reduced physical performance among female soccer players. The aim of this study was to check the frequency of low energy availability appearance in a group of women training soccer, which could results in negative health effects due to Relative Energy Deficiency in Sport (RED-S). Thirty-one professional female soccer players practicing on different league levels (Extra-league, I league, II league) participated in the study. The participants had their height and body mass measured. To assess the Energy Intake the method of 3-day dietary food recording was used. Total Energy Expenditure (TEE) and Exercise Energy Expenditure (EEE) was measured by means of an Armband SenseWear Pro3 device. The content of fat free mass was assessed with Akern BIA 101 Anniversary Sport Edition device. The body mass median of participants was 58 kg. The average height was 166±5 cm, and the average BMI was 21.4±2 kg/m2. TEE was 2703±392 kcal/day, while EEE was 515 kcal (203-597 kcal). Energy intake was 1548±452 kcal/day. Energy availability was 25±11 kcal/kg fat free mass/day. Twenty of the study participants had low energy availability. The percentage of EEE in TEE was 17.93±3.14%. Low energy availability was demonstrated in the vast majority of studied group, which may lead to negative health consequences or reduction of exercise capacity.

Assessment of dietary diversity, antenatal care, food taboos, meal frequency, and nutritional status of pregnant adolescents in rural Malawi: a cross-sectional study

High rates of pregnancy during adolescence in Malawi compromise the nutritional status of adolescent mothers and their infants. When a pregnant adolescent is malnourished, she is at risk for health complications. Research focusing on the nutritional status of pregnant adolescents in Malawi is minimal. The purpose of this study was to assess dietary diversity, antenatal care, food taboos, meal frequency, and nutritional status of pregnant adolescents in rural Malawi. The study included sixty-two pregnant adolescents between 15-19 years old. Data collection included the use of a pre-tested questionnaire, standardized dietary diversity survey and measurements of mid-upper arm circumference (MUAC), height, and hemoglobin. Statistical analysis included descriptive analysis, linear and logistic regression. Mean (SD) age was 17.7 (1.2) years. Mean MUAC was 25.9 (2.0) cm; 31% had MUAC <25 cm. The occurrence of stunting was 19% and 21% were ≤150 cm tall. The mean hemoglobin was 10.37 (1.93) g/dL and 66% were anemic. The mean dietary diversity score was 4.06 (1.18) and 69% did not achieve minimum dietary diversity (score ≥ five.) No participants consumed dairy and only 7% consumed eggs. Eating meat and poultry or dark green leafy vegetables predicted a 1.31g/dL (pvalue = 0.0306) or 1.08 g/dL (p-value =0.0331) increase in hemoglobin levels, respectively (R 2 =0.15). Food taboos during pregnancy were common (35%). Compared to the Malawi National Nutrition Guidelines, 87% were not eating daily from each of the six food groups and 74% were not meeting the recommended meal frequency during pregnancy (three meals and at least one snack/day). Less than 50% consumed foods from legumes/nuts and animal food groups. The majority (63%) did not take antenatal supplements and only 37% consumed ferrous sulfate. Only 52% received advice about nutrition during pregnancy and few (8%) received advice about infant and young child feeding. Girls who received nutrition advice were more likely to take an iron supplement [OR=4.19 (1.82-9.68), p =0.0008] compared to those who did not. As the number of antenatal visits increased, the participants were more likely to take a supplement [OR=11.88 (3.40-41.49) p =0.001]. Interventions for pregnant adolescents in rural Malawi should occur early in pregnancy and include education on dietary diversity, increasing hemoglobin levels, meal frequency, food taboos, antenatal supplements and infant and young child feeding. Keywords: Adolescent nutrition, Pregnant adolescents, Dietary diversity, Food taboos, Hemoglobin Afr. J. Food Agric. Nutr. Dev . 2019; 19(3): 14555-14570

Jordanian Nursing Homes: Admission Policy Analysis

DESCRIPTION OF PROBLEM SITUATION: Although the elderly have many physical, mental, and psychosocial needs, nursing homes are still a new emergent concept in Jordan. Moreover, the elderly who have access to nursing homes, are often not admitted, based on specific criteria, nor have access to governmental funds. The elderly that are admitted to nursing homes are admitted for a myriad of reasons, such as families&amp;rsquo; desires, referrals from the ministry of social welfare due to socioeconomic issues, health issues (i.e. disability), and absence of caregivers (Al-Qudah, 2011). What is lacking in Jordan, is a well-defined admission and screening tool that clearly defines eligibility for nursing home admission&#x0D; &#x0D; POLICY ALTERNATIVE: The policy alternative is leaving Jordanian elderly with special needs in their homes without receiving appropriate care predisposing the elderly to a higher risk of health complications. North Carolina has been chosen as an example of a state that implements a screening tool for admission. &#x0D; &#x0D; RECOMMENDATIONS: The Ministry of Social Development might tailor the NC Medicaid forms (Level I and Katz and MoCA, and Level II of the NC Medicaid screening tool) as an admission screening policy that could be successful in identifying the eligible older adults to admit to nursing homes and receive designated aids from the Jordanian governmental organizations.

Fifty Shades of Stigma: Exploring the Health Care Experiences of Kink-Oriented Patients

IntroductionThe term kink describes sexual behaviors and identities encompassing bondage, discipline, domination and submission, and sadism and masochism (collectively known as BDSM) and sexual fetishism. Individuals who engage in kink could be at risk for health complications because of their sexual behaviors, and they could be vulnerable to stigma in the health care setting. However, although previous research has addressed experiences in mental health care, very little research has detailed the medical care experiences of kink-oriented patients. AimTo broadly explore the health care experiences of kink-oriented patients using a community-engaged research approach. MethodsAs part of the Kink Health Project, we gathered qualitative data from 115 kink-oriented San Francisco area residents using focus groups and interviews. Interview questions were generated in collaboration with a community advisory board. Data were analyzed using a thematic analysis approach. Main Outcome MeasuresThemes relating to kink-oriented patients' experience with health and healthcare. ResultsMajor themes included (i) kink and physical health, (ii) sociocultural aspects of kink orientation, (iii) the role of stigma in shaping health care interactions, (iv) coming out to health care providers, and (v) working toward a vision of kink-aware medical care. The study found that kink-oriented patients have genuine health care needs relating to their kink behaviors and social context. Most patients would prefer to be out to their health care providers so they can receive individualized care. However, fewer than half were out to their current provider, with anticipated stigma being the most common reason for avoiding disclosure. Patients are often concerned that clinicians will confuse their behaviors with intimate partner violence and they emphasized the consensual nature of their kink interactions. ConclusionLike other sexual minorities, kink-oriented patients have a desire to engage with their health care providers in meaningful discussions about their health risks, their identities, and their communities without fear of being judged. Additional research is needed to explore the experiences of kink-oriented patients in other areas of the country and internationally.

Is Early Bariatric Surgery the Answer for Diabetes in Obesity?

The article by Aung et al1 in this issue of JAMA Surgery continues the excellent clinical research from the group in Taiwan.Multiple randomized studies havedemonstrated the efficacy of bariatric surgery in treatingtype2diabetes (T2D), and the term metabolic surgery is being increasingly used, although it is not alwayswell defined. In their introduction, Aung and colleagues define this surgery as “the application of bariatric surgical procedures to patients with a body mass index (BMI) (calculated as weight in kilograms divided by height inmeters squared) of less than 35who also have severe comorbidities.”1 We feel defining it as the manipulation of the gastrointestinal tractwith the goal of treatingT2D isnot only more appropriate but also more representative of what the authors have evaluated in their study. In this article, the authors compare the outcomes of bariatric surgery in those with early-onset T2D (age <40 years) and late-onset T2D (age ≥40 years) and conclude that early intervention leads to better ratesofcompletediabetes remission (hemoglobinA1c<6.0% [toconvert toproportionof totalhemoglobin,multiplyby0.01] without antidiabetic medication).1 Previous studies have shown that the duration of diabetes,useof insulin,degreeofpostoperativeweight loss, andtype of surgeryperformed can influence the remission rates of diabetes following bariatric surgery.2 The studybyAung and colleagues shows that age at diabetes onset canbeused as an additionalpredictorof success,whichsuggestseitheradifference in the pathophysiology of early-onset diabetes or preserved pancreatic reserve in young patients, as inferred by higher C-peptide levels. These data are in keepingwith a 2016 study by Inge et al3 showing a 95%diabetes remission rate at 3 years in their adolescent cohort (aged 13-19 years). Taken together, there appears to be an amassing body of data in support of early consideration of bariatric surgery for obese individualswithT2D. This not only has thepotential to reduce their long-termneed for multiple medications but also has the potential to significantly mitigate their risks of health complications compounded over their lifetime. Thestudy’s5-yearoutcomesareamajor strengthof this article. Although the follow-up ratewas around 50%, these data pointsarerareandvaluabletothefield.Theauthorsaretobecongratulatedforcollectingthesedata,whichreveal thatT2Drecurrence,anAchillesheelofbariatricsurgery,occurseveninthemost idealofpatients—onewithearlyonsetandshortdurationofT2D. Thus, identifyingmarkersof long-termT2Dremissionis,andwill continue to be, an area of heavy interest in the field.

HCV knowledge among a sample of HCV positive Aboriginal Australians residing in New South Wales

Australian Aboriginal and Torres Strait Islanders are overrepresented in both the prevalence and incidence of the hepatitis C (HCV). HCV knowledge has been associated with a range of positive health behaviours. HCV knowledge has previously been investigated as a single construct; however examining different knowledge domains (i.e. transmission, risk of complications, testing and treatment) separately may be beneficial. This study investigated whether having greater HCV knowledge in different domains is associated with self-reported positive health behaviours. 203 Aboriginal people living with HCV completed a survey assessing HCV knowledge, testing and care, lifestyle changes since diagnosis and treatment intent. Respondents’ knowledge was relatively high. Greater knowledge of risk of health complications was associated with undertaking more positive lifestyle changes since diagnosis. Respondents testing and treatment knowledge was significantly associated with incarceration, lifestyle changes since diagnosis and future treatment intentions. This study illustrates the importance of ensuring that knowledge is high across different HCV domains to optimise a range of positive health behaviours of Aboriginal people living with HCV. Future health promotion campaigns targeted at Aboriginal people living with HCV could benefit from broadening their focus from prevention to other domains such as testing and treatment.

Longitudinal Correlates of Health Risk Behaviors in Children and Adolescents with Type 2 Diabetes

To characterize, during a 2-year period, the proportion of youth with type 2 diabetes (T2D) enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth study that reported ever at least trying smoking cigarettes and/or drinking alcohol. Longitudinal data were examined for participants with T2D ages 10-18 years at baseline. Youth psychosocial, parent/family, environmental, and biological correlates of trying health risk behaviors were tested via cross-sectional multivariate models at each time point. Longitudinal models were explored for selected factors. Data were obtained from the Treatment Options for Type 2 Diabetes in Adolescents and Youth study's ethnically diverse participants at baseline (N=644), 6-month (N=616), and 24-month (N=543) assessments. The percentage of youth ever trying only smoking remained stable at 4%; only drinking alcohol increased from 17% to 26%, and both smoking and drinking increased from 10% to 18% during the 2-year period. Factors related to trying health risk behaviors were older age, male sex, non-Hispanic white race-ethnicity, lower grades, more depressive symptoms, and stressful life events. Depressive symptoms, stressful life events, and body mass index Z-score (the latter with smoking only) were related to engagement in health risk behaviors over time. Youth with T2D who are already at risk for health complications and who reported engaging in activities that further increase the likelihood of life-threatening morbidities were characterized. Although most correlates of trying these risk behaviors are nonmodifiable, intervention efforts may need to focus on potentially modifiable factors, such as depressive symptoms and lower grades.

Micronuclei in Diabetics and Smokers

Aim: This article reviews the MN assay with respect to oral buccal mucosa, which has been used since the 1980s to demonstrate the characteristics of micronuclei and frequency of micronuclei in smokers and diabetes. Objective: To compare the frequency of micronuclei and metanucleated anomalies in the oral mucosa of smokers and diabetes. Background: Micronuclei are structures that present after genomic damages to the cells. They are fragments or whole chromosomes, which did not reach spindle poles during mitosis and remained encapsulated at telophase in a separate nucleus. Micronuclei frequency is a sensitive biomarker used to evaluate the genotoxicity induced by xenobiotics. The buccal cell micronucleus (MN) assay was first proposed in 1983. Diabetes mellitus (DM) is associated with a high risk of health complications, mainly to excessive free radical (FRs) production that could result in an increased frequency of micronuclei. Carcinogenic and mutagenic compounds, are responsible for the induction of micronuclei. These compounds are produced from nicotine by bacterial or enzymatic activity. The same formation occurs in the mouth under the influence of saliva. Reason: To estimate the frequency of micronuclei in diabetes and smokers in order to access the genetic damage

Psychosocial predictors of salivary cortisol among older adults with depression.

ABSTRACT Background: Previous studies have identified a number of psychosocial risk factors of dysregulated cortisol (frequently referred to as the "stress hormone") among older adults with depression. However, these studies have typically only examined a handful of risk factors at a time and have sometimes yielded inconsistent results. Method: This study aims to address this gap in the literature by simultaneously examining a range of relevant psychosocial predictors of diurnal cortisol among 54 older adults with a depressive disorder. Salivary cortisol was assessed upon awakening, at 5 PM, and at 9 PM across two consecutive days. Participants also completed measures of global psychosocial stress, current psychiatric symptomatology, pervasive distress (e.g. history of past depression), and protective factors (e.g. social support, resiliency, extent to which one has "made sense" of a significant stressor). Results: High levels of current depressive symptoms, psychiatric comorbidities, past depressive episodes, trait anxiety, and poorer ability to make sense of one's stress were found to be associated with flatter (more abnormal) cortisol slopes. However, when all of these variables were entered simultaneously in a multiple regression analysis, only history of past depression and the degree of sense made of stress emerged as unique predictors of cortisol in the model. Conclusions: These findings have important implications for identifying depressed elderly individuals with dysregulated cortisol patterns who may be most at risk for health complications. Treatments that aim to limit the chronicity of depression and help to increase the sense made of stress could potentially have a positive impact on health.

Listeriosis: how concerned should a pregnant woman be? (1019.27)

Background: Every year, at least one major Listeria monocytogenes (Listeria) outbreak occurs within the United States. If pregnant women are uninformed of possible ramifications of contracting Listeria, the mother and child are at risk for health complications. One possibly effective communication approach to this population regarding prevention and risk is through Listeria Educational Materials (LEM). In order to ascertain the status and effectiveness of currently available LEM for pregnant women, a systematic literature review was conducted.Methods: Literature searches were conducted using widely accepted public/private databases. The mesh terms used included “Listeria pregnancy”, “listeria education”, “Listeriosis”, “Listeria pregnancy prevalence” “Listeria monocytogenes”. Only articles published within the past 10 years pertaining to educational materials for pregnant women were evaluated. Articles relating to general information of Listeria, were also narrowed to specific characteristics, traits, and origin for exposure. References to Listeria in elderly and immunocompromised individuals were excluded.Results: 4 studies involving Listeria interventions including LEM for pregnant women were identified. These studies all concluded a majority of pregnant women were still not provided with sufficient information on infection prevention of Listeria. Most educational materials provided to the women were in the form of pamphlets, and the majority of pregnant women who had heard of Listeria gathered the information through their own research efforts.Conclusions: The current evaluation of the available studies concludes there is inadequate emphasis placed on educational interventions for pregnant women regarding Listeria risk. These interventions concluded more must be done to inform these pregnant women of the dangers of Listeria as well as on the high‐risk foods they consume on a daily basis.

The Connection between Psychosocial Health, Health Behaviors and the Environment In Rural Children

Overweight and obesity is a concern for child populations in many countries. Due to a high prevalence of sedentary activity, low physical activity, and unhealthy diet, many children are at serious risk for health complications. Overweight and obesity seem to be of particular concern for Canadian children living in rural environments. A recent pilot study examined the physical and emotional health status of children in grades 4, 5, and 6 from four rural schools in Saskatchewan. Quantitative data was collected using four validated instruments: the Piers Harris 2, the Faces Scale, the Youth/Adolescent Questionnaire (Food Frequency), and the Physical Activity Questionnaire, as well as measured heights and weights. Qualitative data was collected using Photovoice, a research methodology that encourages expression through photography. This was used to explore the children’s perception of the rural environment, and whether they felt it helped or hindered their abilities to maintain health. Results revealed a high proportion of overweight and obesity. There were no significant differences in weight status between girls and boys. However, most children indicated that they were happy living in the rural environment. Three themes emerged from the Photovoice component: satisfaction, wide-open spaces, and a sense of safety. The rural environment appears to contribute to children’s health and happiness and thus should be fully utilized in interventions and health promotion activities that promote health and healthy behaviours in children.

Reaching out in Richmond

Reaching out in Richmond

Expanding Outreach of a Diabetes Self-management Education Program to Antigua

Objective: Take Charge of Your Diabetes (TCYD) is a collaborative diabetes self-management education program designed by Florida extension faculty. The Florida Department of Health funds training and provides technical support. The objective of this project was to expand TCYD outreach to Antigua. Use of Theory or Research: TCYD was designed with the health belief model. Target Audience: Persons with type 2 diabetes living in Antigua. Description: Working collaboratively with the Antigua Medical Benefits Scheme, we planned a January 2010 visit to the island nation, including 1 day of orientation to their health care system to learn their approaches to diabetes self-management education. We worked with 30 Antiguan health professionals, including dietitians, nurses, diabetes educators, and pharmacists, for 3 days, providing research updates and training on program planning, implementation, and evaluation, including ideas for adapting the program for their population. Evaluation: The health professionals were enthusiastic about the training and TCYD, and the program was implemented within 3 months. The Medical Benefits Scheme reported dramatic improvements in self-care practices among participants, and the average hemoglobin A1C level decreased by 2.2%, a significant change that can have profound effects on risk for health complications. A second program is currently being implemented and future expansion is planned. We continue to provide research and program updates. Conclusions and Implications: TCYD can be adapted for use in other cultures when local health professionals receive detailed training and local support for program implementation. Funding: Medical Benefits Scheme, Antigua.

Counterpoint: Sickle cell trait should not be considered asymptomatic and as a benign condition during physical activity

Counterpoint: Sickle cell trait should not be considered asymptomatic and as a benign condition during physical activity

RESEARCH ISSUES IN NUTRITION SUPPORT

Nursing scientists have made important contributions to the understanding of individual responses to nutritional support as well as factors that place patients at risk for health complications. In addition, they have begun to incorporate measures of quality of life, function, and satisfaction into their outcome measures. This article focuses on describing the current state of nursing science related to nutrition support and issues related to the evaluation of research for implementation into practice.