Miami-Dade County has approximately 27,000 people living with HIV (PLWH), and the highest HIV incidence in the nation. PLWH have reported several types of sleep disturbances. Caffeine is an anorexic and lipolytic stimulant that may adversely affect sleep patterns, dietary intakes and body composition. High caffeine consumption (>250 mg. per day or the equivalent of >4 cups of brewed coffee) may also affect general functionality, adherence to antiretroviral treatment (ART) and HIV care. This study assess the relationship of high caffeine intake with markers of disease progression, sleep quality, insomnia, anxiety, nutritional intakes and body composition. A convenience sample of 130 PLWH on stable ART were recruited from the Miami Adult Studies on HIV (MASH) cohort, and followed for three months. After consenting, questionnaires on Modified Caffeine Consumption (MCCQ), Pittsburg Insomnia Rating Scale (PIRS), Pittsburg Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), socio-demographics, drug and medication use were completed. CD4 count, HIV viral load, anthropometries, and body composition measures were obtained. Mean age was 47.89±6.37 years, 60.8% were male and 75.4% were African-Americans. Mean caffeine intake at baseline was 337.63 ± 304.97 mg/day (Range: 0-1498 mg/day) and did not change significantly at 3 months. In linear regression, high caffeine consumption was associated with higher CD4 cell count (β=1.532, P=0.049), lower HIV viral load (β=-1.067, P=0.048), higher global PIRS (β=1.776, P=0.046), global PSQI (β=2.587, P=0.038), and GAD-7 scores (β=1.674, P=0.027), and with lower fat mass (β=-0.994, P=0.042), energy intakes (β=-1.643, P=0.042) and fat consumption (β=-1.902, P=0.044), adjusting for relevant socioeconomic and disease progression variables. Over three months, these associations remained significant. The association of high caffeine with lower BMI weakened when excluding users of other anorexic and stimulant drugs such as cocaine and methamphetamine, suggesting that caffeine in combination, but not alone, may worsen their action. In summary, high caffeine consumption was associated with better measures of disease progression; but was also detrimental on sleep quality, nutritional intakes, BMI and body composition and associated with insomnia and anxiety. Large scale studies for longer time are needed to elucidate the contribution of caffeine to the well-being of PLWH.

Congestive heart failure (CHF) is a progressive medical condition affecting more than 7 million people in the United States (US) with 700,000 new cases reported annually. More than half of those treated for CHF are readmitted at least once a year. The problem addressed by this quality improvement initiative was lack of adherence to low sodium diet (LSD) among CHF patients, knowledge and skill deficit, and excessive 30-day CHF readmissions. The health belief model and the self-care deficit theory guide nurses in acquiring the skills needed to teach LSD. Twelve months of data were selected from 93 CHF readmissions from a target population of 499 CHF admissions. Measures of central tendency were used to extract meaningful summaries between variables for patterns related to 30-day readmissions and to plan educational interventions to improve patient outcomes. The educational intervention focused on educating nurses to teach adult patients with CHF to adopt a LSD. Discharge teaching materials developed were standardized, customizable, evidence-based, and included opportunities for evaluation of patient understanding and reteaching as necessary. Analysis of variance was conducted to evaluate the difference between days to readmission and compliance with the patient education process, and no significant difference (p < .05) was found (F(3,89) = .314, p = .815). The implications of this project for social change include preparing nurses to teach patients to adopt a LSD, empowering CHF patients to improve health outcomes, and improving the financial outcomes related to CHF.

Malnutrition among hospitalized patients is prevalent and associated with adverse outcomes. At the health care facility for which this quality improvement (QI) initiative was developed, patients were not consistently fed within the nationally recommended 48 hours. The purpose of this project was to facilitate the early initiation of enteral feedings to prevent malnutrition in a vulnerable patient group by development of an evidence-based enteral feeding policy, algorithm, and nursing education module. The find, organize, clarify, understand, select, plan, do, check, and act model provided a systematic approach for development of the project. Validation of the QI initiative was through the use of Likert scale which was completed by 2 nurses and a head dietician. The content validity index average was 1.0 for the QI initiative products (policy, algorithm, educational module). Ten team members completed a summative evaluation of the educational module and presentation using a 7 item, Likert scale. Basic descriptive analyses were employed to analyze the data, revealing broad support for the module and the DNP student's leadership. A recommendation was made to conduct an audit using a formal software program to quantify the number of patients who were not being fed within the time frame of 48 hours. Implementing an evidence-based enteral feeding protocol can be a significant intervention that produces better patient outcomes.The implications for social change in this project relates to improvements within the critical care environment.

Hyperlipidemia caused by a diet high in saturated fat can lead to visceral fat weight gain, obesity, and metabolic syndrome. Being over-weight from visceral fat has been linked to increased risk of developing most age-related diseases and disability, along with a lower income potential and quality of life. However, researchers are just beginning to understand the biological mechanisms that regulate the conversion of excess calories into visceral fat storage rather than glycogen or muscle. Epidemiological studies have repeatedly shown a comorbid association between age-related diseases involving hyperlipemia and circulating levels of uric acid, but not a direct association. This study utilized archival data from 31 healthy, middle-aged adults, who participated in a randomized, double-blind, crossover clinical trial on blood markers of lipidemia and inflammation following a high saturated fat (HSF) verses a "healthy" polyunsaturated fat (PUFA) meal. This primary study was conducted and funded by the National Institute on Aging. A secondary analysis of this data using Pearson's correlation with least squares (2-tailed) regression modeling found that when stratified by gender, baseline uric acid level was an independent and significant predictor of the lipemic response from the HSF, but not the PUFA meal. The linear regression plots indicated that males with uric acid levels above 4.5, and females above 3.0 mg/dL, had a progressively increased lipemic response to the HSF meal. The public health utility of this finding may include the clinical use of the gender-specific linear regression plots of uric acid values to identify and advise individuals at risk for hyperlipidemia from a diet high in saturated fats.

The adequate intake of micronutrients is important to maintain optimal health and prevent nutritional disorders and chronic disease. Studies have shown that medical students often reduce self-care behaviors and lack adequate dietary intake, leading to nutritional deficiencies. In this quantitative cross-sectional study, measurements of micronutrient levels in a sample of allied health and nursing students were compared to Recommended Daily Allowance (RDA) values. NutritionQuest Data-on-Demand System was used to analyze nutrients and food group intake. The postpositivist paradigm was used to examine how the independent and dependent variables relate to each other. Using a one-sample t test, a comparison of average micronutrient intake among study participants with RDA values for those micronutrients showed that average micronutrient intake in the study population was higher than recommended values. Two sample t-test results showed no significant difference in average intake of micronutrients among participants with high and low income levels, or with high and low stress levels. As the normality assumption was not satisfied by the outcome variables, nonparametric tests were used to evaluate hypotheses. While this finding does not support the original hypothesis, it could have implications for the role of allied health and nursing practitioners in the care of both their patients and members of their medical team. Conversely, an assumption of this study was that a high level of similarity between the traditional medical student population and the allied health and nursing population in terms of nutritional habits may have led to a flaw in the overall research hypothesis. The detection of micronutrient deficiencies in students can bring awareness to improve nutritional intake and initiate a change in how public health officials advocate healthy and balanced diets.

Eating disorders are associated with high mortality rates. Most eating disorder prevention research is conducted within the fields of psychology and psychiatry, not in public health. This gap in public health research can lead to insufficient attention to the root causes of eating disorders and minimal upstream prevention efforts. The purpose of this phenomenological study was to identify public health leaders' perceptions of and attitudes concerning eating disorders as a public health issue. Objectification theory was used to describe how societal expectations have created an environment in which people's self-worth is based on their outward physical appearance. Ecological theory was used to identify environmental factors that influence the development of eating disorders. Public health leaders at local public health departments throughout California were invited to participate in the study, as they hold significant public health positions in the state. Data were collected using open-ended questions. Results were coded and analyzed via thematic analysis. NVivo 11 software was used for data management. Theoretical saturation was reached after 6 interviews when the information was redundant and no new themes were revealed. Emerged themes included observations from the participants that eating disorders are not considered a public health issue. The participants did not view eating disorders as a significant problem and they noted that they do not monitor the rates of these illnesses. They expressed interest in exploring the public health role in eating disorder prevention. Public health educators, researchers, and leaders can use these results to assess the burden of eating disorders and recognize ways to address this health threat at the macro level. In doing so, they will affect positive social change.

A disabling condition in old age is poor cognitive function (CF), which affects more than 16 million people in the United States. Research has correlated oxidative stress with poor CF, and antioxidants have been suggested as a means to counteract this impact, although there are inconsistencies in the literature. Guided by the oxidative stress theory of aging, the purpose of this study was to determine the relationship between blood serum antioxidant levels and CF in participants aged 60 and older. This cross-sectional study used data from the National Health and Nutrition Examination Survey from 2001 2002 (n = 291). Correlation studies were performed using Pearson's correlation coefficient. Multiple linear regression was used to determine whether blood serum antioxidant status predicted CF while controlling for age, gender, race, hypertension, smoking status, and Body Mass Index. Results of this study demonstrated that alpha-tocopherol (r = .257), retinyl palmitate (r = .248), trans-lycopene (r = .196), retinyl stearate (r = .136), age (r = -.239; p < .001), and BMI (r = .189; p = .001) were all significantly correlated with CF. After controlling for covariates, higher concentrations of alpha-tocopherol and retinyl palmitate were associated with higher CF (p < .01). The positive social change implications of this study include interventions designed to educate the elderly about the role of antioxidants in delaying or preventing poor CF or to reduce barriers to healthy eating. By implementing interventions that incorporate data from this study, healthcare professionals may be able to reduce the incidence and prevalence of poor CF in the elderly population.

There are low retention rates of dietitians and this impacts quality of care. Emotional intelligence (EI) may be the missing component to improve retention, due to EI increasing job satisfaction and decreasing burnout for other health providers. The purpose of this study was to examine the relationship between EI, job satisfaction, and burnout for dietitians. The theoretical framework utilized was the 4-branch model of EI. Method of inquiry was convenience, quantitative non-experimental design. Registered dietitians (N = 84,173) living in the United States were contacted via e-mail. Approximately 9.5% of dietitians (n = 8,038) completed the Wong and Law EI Scale, Job Diagnostic Survey, Copenhagen Burnout Inventory, and a demographic survey. Frequency was calculated based on coded data that 89.38% of dietitians indicated high level of EI (score -?¥ 4.5). Levels of EI and burnout for dietitians were examined with a Chi2 (p = 0.000), Pearson r correlation (r = 0.28, p = 0.000), and positive linear regression (r2 = 0.075, p = 0.000). Levels of EI and job satisfaction for dietitians were examined with a Chi2 (p = 0.000), Pearson r correlation (r = 0.271, p = 0.000), and positive linear regression (r2 = 0.070, p = 0.000). Significant findings reveal that dietitians possess increased levels of EI, a positive correlation exists between EI and burnout, and a positive correlation exists between EI and job satisfaction. Results may contribute to social change by highlighting the importance of EI in the field of dietetics to integrate EI in curriculum, encourage professional growth, and improve client outcomes.

Androgen receptor (AR) gene CAG polymorphisms may be associated with body shape, and are associated with certain breast and prostate cancers. In addition, body shape is associated with risk for a variety of diseases, including heart disease, diabetes, and certain forms of cancer. The CAG repeat in exon l of the AR gene was quantified using Perkin Elmer Applied Biosystems GeneScan analysis software in 96 and 59 healthy Caucasian men and women, respectively, who were over the age of 50 years. All participants had body measurements taken and donated a blood sample. Waist measurements included circumferences at the 1) umbilicus (wstumb), 2) top of the iliac crest (wstili), and 3) midpoint between the lowest rib and the iliac crest (wstwst). Waist-hip ratio (Wl-IR) was calculated using each corresponding waist measurement, respectively (WHRUMB, WHRILI, WHRWST). Mean repeat length was significantly different (p < 0.01) between men (22 ± 0.3 repeats) and women (23 ± 0.3 repeats). There was a significant relationship (p < 0.05) between mean individual CAG repeat number and tertile of WHRUMB in women based on the mean number of CAG repeats for each woman. Waist measurements in women were significantly different for all pairwise comparisons (p < 0.05). In addition, the three measurements of WHR in women, WHRUMB, WHRILI, and WHRWST, were significantly different from each other (p < 0.05). Thus, lesser numbers of CAG repeats may indicate a more androgenic phenotype in women.

Prior studies have unequivocally established a consistent association between osteoporotic hip fracture risk and type 2 diabetes mellitus. One reason this association still remains unclear is primarily due to the limited amount of research conducted in this area. The Utah Study of Nutrition and Bone Health (USNBH) is a case-control study conducted in Utah during the period of 1997-2001 to determine risk factors for osteoporotic hip fracture. All study participants (n = 2590) were determined from Utah residents 50-90 years of age. Cases were determined from 18 Utah hospitals during 1997-2001. Age and gender-matched controls were randomly selected from the Utah Drivers License pool if less than 65 years of age and the Medicare databases if greater than 65 years of age. Logistic regression models were used to determine the association between type 2 diabetes and hip fracture risk. Logistic regression modeling controlled for gender, body mass index, smoking status, alcohol use, physical activity, education level, and estrogen use in women. The risk of hip fracture was associated with type 2 diabetes. The significant correlation was primarily found in females in which the risk of hip fracture increased accompanying diagnosis of type 2 diabetes. Estrogen usage in females decreased (p < 0.0001) hip fracture risk in both former or current users. Physical activity significantly decreased the risk of hip fracture for females (p < 0.0001) and for males (p = 0.001). Smoking and alcohol use may increase the risk of hip fracture, especially in women. This study substantiates the hypothesis that type 2 diabetes mellitus increases the risk of hip fracture.