California school board members' perceptions of factors influencing school nutrition policy

Enactment and enforcement of school nutrition policies represent key components in adolescent overweight and obesity prevention. This study determined: 1) California school board members' attitudes, perceptions, and motivations related to enactment of policies that support healthy eating in schools; and 2) barriers to adopting school policies that support healthy eating. To understand board members' decision-making process, key informant interviews were conducted and a survey was administered to 404 school board members. Though school board members care about the well-being of pupils, competing priorities limit the extent to which nutrition issues get addressed at board meetings. Members' decisions center primarily around academic achievement issues, yet they are interested in nutrition's overall impact on children's health and academic achievement.     

An explanatory model of health promotion and quality of life in chronic disabling conditions

BACKGROUND: Although previous studies have examined selected factors influencing health-promoting behaviors or quality of life, the complex interplay of these variables in persons with chronic disabling conditions has not been investigated. OBJECTIVE: To test an explanatory model of variables influencing health promotion and quality of life (Stuifbergen & Rogers, 1997) in persons living with the chronic disabling condition of multiple sclerosis (MS). METHODS: A sample of 786 persons with MS (630 women and 156 men) completed a battery of instruments measuring severity of illness-related impairment, barriers to health-promoting behaviors, resources, self-efficacy, acceptance, health-promoting behaviors, and perceived quality of life. The proposed model was assessed and modified using the weighted least squares procedure (WLS), which is implemented by LISREL8 (Joreskog & Sorbom, 1993). RESULTS: The initial model was modified to obtain a recursive model with adequate fit, chi2 (8, N = 786) = 77, p < 0.05; GFI = 0.96; IFI = 0.98; CFI = 0.98. The antecedent variables accounted for 58% of the variance in the frequency of health-promoting behaviors and 66% of the variance in perceived quality of life. The effects of severity of illness on quality of life were mediated partially by health-promoting behaviors, resources, barriers, self-efficacy and acceptance. CONCLUSIONS: The final model supports the hypothesis that quality of life is the outcome of a complex interplay among contextual factors (severity of illness), antecedent variables (Stuifbergen & Rogers, 1997), and health-promoting behaviors. The strength of direct and indirect paths suggests that interventions to enhance social support, decrease barriers, and increase specific self-efficacy for health behaviors would result in improved health-promoting behaviors and quality of life. Further research using a longitudinal design is needed to clarify the effects of the interaction between health-promoting behaviors and trajectory of illness on quality of life for persons with chronic disabling conditions.     

Nurses' information management and use of electronic tools during acute care handoffs

Little evidence is available about nurses' use of electronic tools during handoffs. This qualitative study explored information management and use of electronic tools during nursing handoffs. The sample included 93 handoffs by 26 nurses on 5 medical/surgical units in 2 western hospitals with a robust electronic health record (EHR). Data collection included audiotaping handoffs, semi-structured interviews, observations, and fieldnotes. The dataset was inductively coded into 33 categories and 5 themes: good nurse expectations for handoffs, paper forms are best, information at a glance, only pertinent information please, and information tools that work. Two-thirds of the nurses abandoned use of the leadership-endorsed electronic handoff form, preferring personal paper forms. The findings suggest effective electronic solutions will require extensive contextually-based information, information integrated across EHR modules and portable, electronic support throughout shifts. This is a call to action for leaders and informaticists as they select and design future electronic tools.     

Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses' handoffs on medical and surgical units: insights from interviews and observations

Patient care handoffs are cognitively intense activities, especially on medical and surgical units where nurses synthesize information across an average of four to five patients every shift. The objective of this study was to examine handoffs and nurses' use of computerized patient summary reports in an electronic health record after computerized provider order entry (CPOE) was installed. We observed and audio taped 93 patient handoffs on 25 occasions on 5 acute care units in 2 different facilities sharing a vendor's electronic health record. We found that the computerized patient summary report and the electronic health record were minimally used during the handoff and that the existing patient summary reports did not provide adequate cognitive support for nurses. The patient summary reports were incomplete, rigid and did not offer "at a glance" information, or help nurses encode information. We make recommendations about a redesign of patient summary reports and technology to support the cognitive needs of nurses during handoffs at the change of shift.     

An explanatory model of health promotion and quality of life for persons with post-polio syndrome

Although previous studies have examined selected factors influencing health promoting behaviors or quality of life, the complex interplay of these variables in persons with different chronic disabling conditions has not been investigated. This study tested an explanatory model of variables influencing health promotion and quality of life originally developed with a sample of persons with multiple sclerosis in a new sample of persons living with post-polio syndrome (PPS) in the USA. The sample of 1603 persons with PPS (1123 females, 478 males and 2 unknown) completed a battery of instruments including measures of severity of polio-related impairment, barriers to health promoting behaviors, resources, self-efficacy, acceptance, health promoting behaviors and perceived quality of life. A model originally developed in a sample of 786 persons with multiple sclerosis was assessed and modified using the weighted least squares procedure (WLS) which is implemented by LISREL8. The structural equation analyses resulted in a proper solution that exhibited adequate fit: chi2 (8, N = 1549)=84.22, p<0.05; GFI=0.96, IFI=0.90, CFI=0.90. The antecedent variables accounted for 65% of the variance in the frequency of health promoting behaviors and 53% of the variance in perceived quality of life. The model test supports the hypothesis that quality of life is the outcome of a complex interplay between contextual factors (severity of impairment), antecedent variables, and health promoting behaviors. It also suggests that the relationships among these variables are similar in samples of persons with two different chronic conditions. Further research using a qualitative approach is needed to clarify other contributors to quality of life in persons with post-polio syndrome.     

Rapid Implementation of a Complex,Multimodal Technology Response to COVID-19 at an Integrated Community-Based Health Care System

Background  The rapid spread of severe acute respiratory syndrome coronavirus-2 or SARS-CoV-2 necessitated a scaled treatment response to the novel coronavirus disease 2019 (COVID-19). Objective  This study aimed to characterize the design and rapid implementation of a complex, multimodal, technology response to COVID-19 led by the Intermountain Healthcare''s (Intermountain''s) Care Transformation Information Systems (CTIS) organization to build pandemic surge capacity. Methods  Intermountain has active community-spread cases of COVID-19 that are increasing. We used the Centers for Disease Control and Prevention Pandemic Intervals Framework (the Framework) to characterize CTIS leadership''s multimodal technology response to COVID-19 at Intermountain. We provide results on implementation feasibility and sustainability of health information technology (HIT) interventions as of June 30, 2020, characterize lessons learned and identify persistent barriers to sustained deployment. Results  We characterize the CTIS organization''s multimodal technology response to COVID-19 in five relevant areas of the Framework enabling (1) incident management, (2) surveillance, (3) laboratory testing, (4) community mitigation, and (5) medical care and countermeasures. We are seeing increased use of traditionally slow-to-adopt technologies that create additional surge capacity while sustaining patient safety and care quality. CTIS leadership recognized early that a multimodal technology intervention could enable additional surge capacity for health care delivery systems with a broad geographic and service scope. A statewide central tracking system to coordinate capacity planning and management response is needed. Order interoperability between health care systems remains a barrier to an integrated response. Conclusion  The rate of future pandemics is estimated to increase. The pandemic response of health care systems, like Intermountain, offers a blueprint for the leadership role that HIT organizations can play in mainstream care delivery, enabling a nimbler, virtual health care delivery system that is more responsive to current and future needs.     

Toward Controlling the Formation,Degradation Behavior,and Properties of Hydrogels Synthesized by Aza‐Michael Reactions

The aza‐Michael reaction of amino‐functionalized polymers with acrylate and acrylamide crosslinkers for the formation of hydrogels is investigated. It is studied how far the reaction conditions (pH value, chemical structures of the compounds involved) influence the crosslinking and degradation rate of the gels. When crosslinking the polymer poly(1‐glycidylpiperazine), high pH values lead to fast crosslinking. Fast degradation of β‐aminoester crosslinks is observed when acrylate crosslinkers are used due to a neighboring group effect. With acrylamide crosslinkers, hydrolytically stable gels are formed, in which the shear moduli and swelling ratio can be adjusted and in which the extracts show no toxic effect on primary human fibroblasts, making them a promising material for biotechnological applications.

     

Results of evaluability assessments of local wellness policies in 6 US school districts

BACKGROUND: A US federal mandate that school districts devise and implement local wellness policies (LWPs) has potential widespread impact on the nutritional content of foods and beverages available in schools and on the amount of physical activity that students engage in; however, evidence concerning the mandate's effectiveness is limited. This study describes the content of LWPs of 6 US school districts and steps taken toward their implementation and evaluation. METHODS: During visits to 6 school districts, we interviewed 88 school and community representatives about the content of their district's LWPs and how the LWPs were being implemented and evaluated. RESULTS: The 6 LWPs were consistent with the federal mandate, although they varied in content and degree of specificity, and none had been fully implemented. All 6 districts were pursuing strategies to ensure that foods and beverages available at school met nutrition standards but did not offer nutrition education to all K‐12 students. All 6 districts offered students only limited opportunities for physical activity, and all 6 collected data to monitor process and outcomes of their LWPs. CONCLUSIONS: Partial implementation of LWPs in the districts we visited resulted in significant improvement in the nutritional quality of foods available at district schools, but only slight improvement in students' opportunities for school‐based physical activity. We provide recommendations for school districts on implementation and evaluation. Future research is needed to determine the impact of these LWPs on students' health.