As the population of older adults in the United States grows, more ways are being explored to encourage an active lifestyle and promote healthy living. Many malls and other sites across the country have established walking programs that provide people ways to get exercise and fulfill social needs. The purpose of this study is to explore quantitatively the numbers and types of people who participate in these programs as well as to describe the physical environment in mall and non-mall settings with walking programs. This study will make use of a modified SOPARC tool, a tool originally designed for assessing park and recreation areas. The tool will be used to capture information on walkers’ observed sex, approximate age, ethnicity, activity level and usage of mobility aids. Information will be collected about the external and internal conditions at the walking sites including information on accessibility, safety and features of interest to the walker. Results will include data gathered at 10 mall and five non-mall sites in five states. It is hoped that the results of this study will show what types of people are using these programs as well as features that are common among the various sites. To date, one mall audit has been conducted. Of 39 walkers observed over 15 minutes, 61% of walkers were male, 77% were older adults, and 74% were of observed Caucasian ethnicity. This site also played special music for the walkers and has an information kiosk where walkers can sign in and record their miles walked. Challenges to older walkers include uneven walking surfaces from the transit stop and small writing on the mall wayfinding map. It is hoped the study will provide a basis to help tailor walking programs to target certain populations and ideas for optimal walking settings to inform a best practices guide for existing and new walking programs.    

Older adults who participate in regular physical activity have better emotional health, as well as reduced mortality and morbidity, compared to older adults who do not participate. Mall walking programs are an existing form of low-cost physical activity for older adults that provide level walking surfaces, security, and other amenities like benches and restrooms. Although some mall walking programs have existed for decades, there is scant evidence supporting this easily accessible form of regular physical activity for older adults. The purpose of this study is to identify and describe actual and perceived costs of existing programs in mall and non-mall locations, such as arenas. As part of a larger study, structured interviews have taken place at ten mall and five non-mall locations in five different states. Mall managers, mall walker program leaders, and program participants have been interviewed over a six-week period. All interviews have been transcribed and coded for anonymity. Cost-related themes from the transcripts have been extracted and added to those identified from an already completed literature review. The data set is being analyzed using the Strauss and Corbin model of grounded theory to identify themes and categories with the intent of developing cost-structure models that reflect successful programs. Themes identified include shared program costs between the site and a hospital, regular blood-pressure testing, and retail stores offering discounted coffee for participants. By identifying best fiscal practices and cost-related variations that encourage the diversity of participants, future efforts may be directed at developing a cost calculator to help programs identify and track their costs. This component may help in establishing low or neutral-cost programs and therefore increase the accessibility of physical exercise to a wider range of older adults. 

Cardiac arrest is a serious and often life-threatening event that can result in devastating outcomes. Targeted temperature management, or TTM, is a treatment utilized after cardiac arrest which improves patient outcomes. Determining the best treatment temperature and combination of sedative and paralytic medications, whose purpose is to slow the brain’s metabolism and maintain brain tissue oxygenation, will improve this beneficial treatment for future patients. The purpose of this study was to compare the time to ‘reawakening’, defined as the patient following commands, between post-cardiac arrest patients who received different combinations of paralytic and sedative medications and who were treated at 33°C or 36°C during TTM. Time to ‘reawakening’ after TTM is a critical factor in this patient population in terms of each patient's prognosis. The sub-aims of this study were to determine if time to ‘reawakening’ was influenced by: 1) cooling patients to the target temperature of only 36°C, and 2) the patient’s temperature when signs of shivering occurred during the TTM protocol. We were interested in studying these two aims because cooling patients to the target temperature of 36 degrees is expected to decrease the incidence of shivering and therefore less sedative and paralytic will be needed. Additionally, knowing what patient temperatures increase the incidence of shivering will better direct the dosing and timing of medications. Data for this study was retrieved through a retrospective chart review of 200 patients who received TTM treatment at Harborview Medical Center. Once we determine which treatment temperature and medication protocol results in the fastest reawakening and least amount of shivering, the results may influence future TTM protocols and could influence the care that future post-cardiac arrest patients receive. TTM could change in a way which ensures patients have the best possible outcomes after experiencing a traumatic event like cardiac arrest.

Internet resources provide an abundance of information about diabetes, mostly without any quality control. Providing resources to patients can be challenging for student and new graduate nurses due to the vast amount of potential websites. We were seeking new ways on how student and new graduate nurses can assess the value of patient websites focused on diabetes. The aims of this study were: 1) to identify the most frequently accessed diabetes websites by (N=142) undergraduate nursing students; 2) to evaluate the data based on quality criteria to see which websites provided the most complete information, and 3) to make website recommendations for patients with diabetes in regards to disease recognition, treatment, safety, and lifestyle choices. This secondary quantitative analysis was conducted with de-identified data from a class assignment at the UW School of Nursing. Websites were accessed a total of (N=399) times. Each website was evaluated for 12 categories with a quality score of 0-9 for each category. A score of 0-3 meant minimal, 4-6 moderate, and 7-9 meant complete information for that category. For each category we took the mean score of all individuals who evaluated that website to determine its strength. After identifying duplicates, a total of (N=53) websites were identified. Based on the highest quality scores, the top 10 websites were four governmental, four non-governmental and two commercial. Of these, the most complete website was diabetes.org with a mean rating of 89.3 out of a possible score of 108. The next two contenders were kidshealth.org and niddk.nih.gov with mean scores of 77.1 and 74.9 respectively. Educating nursing students and new graduates about the value of safety and quality of information on the web will enable them to better inform patients and families. More research is needed if this type of education makes a difference in patient outcomes.

Mall walking provides a safe environment for older adults to engage in physical activity and participate in a social community. Walking has many health benefits, a few of the benefits include reducing the risk of falls, reducing falls, increasing quality of life, increasing cardiac function, a low cost activity, and increasing mobility. However, there is limited data on mall walking as an activity and the benefits it provides for older adults. The purpose of this study is to understand the benefits of mall walking from the perspective of mall walking leaders and mall walking participants. The results of this study will be used to create an Evidence-informed Mall Walking Program Resource Guide which will be used to help start potential programs and to benefit programs already in place. I will utilize a structured interview guide created by the research team and conduct phone or in-person interviews with three mall or non-mall walking leaders and three mall or non-mall walking participants in the Seattle area. The interview guide includes items about how participants learned about the mall walking program, what they like and dislike about mall walking, transportation to and from the mall, how long they have been a part of this walking community, what makes this community successful, and the age and ethnic diversity of the mall walkers. To date, I have completed three interviews of mall walking participants and one interview of a mall program leader. From these interviews I learned mall walking is a great health promoting activity enjoyed by older adults. Participants and leaders alike have found a social community and are able to engage physically, mentally, and psychosocially while walking. By the time of the poster presentation I will have additional data to present on two other mall walking participants and three mall walking leaders.

Adolescent obesity is a growing epidemic and has tripled in the past 20 years in the United States. This is a major public health concern as we are now observing numerous health conditions commonly associated with adult obesity in the adolescent population. The goal of our study is to determine how total sleep time (TST) affects body composition, activity level, and nutrition in adolescents. Our study population consists of 100 healthy 13-17 year old adolescents. We are currently collecting and will analyze data from sleep/hunger/satiety diaries and questionnaires, a watch that records daytime/nighttime activity, 24-hour diet recalls, serum metabolic markers, appetite regulating hormones, salivary cortisol, an air displacement device, and questionnaires that assess lifestyle factors. We anticipate our results will demonstrate differences between sleep-deprived adolescents with age, BMI, sex matched control adolescents in diet, food cravings, physical/sedentary activity, and appetite regulation. Further, we anticipate our results will demonstrate an inverse correlation between TST and body composition. The intent of this study is to provide preliminary information to suggest a need for further research in this area. We hope to apply this scientific understanding to the development and testing of innovative interventions to improve sleep and decrease adolescent obesity and metabolic risk.

Conservatively estimated, about one in every ten youth experiences severe depression during adolescence. This is concerning because depression is known to be responsive to prevention as well as to early interventions when accessible to youth. Those who experience early onset depression are at increased risk for other negative outcomes including substance use and suicidal behavior. The effects of depression carry over into young adulthood and are linked with psychiatric and medical hospitalizations, suicidal behavior, and lower educational accomplishments. Youth identified as academically at-risk are particularly susceptible to experiencing depression as well as other co-occurring health risks. Research reveals that family processes serve as a protective influence on the development of depression. Few studies, however, have examined the role of familial risk and protective factors in the development or progression of depression for academically at-risk youth. This research was designed to investigate patterns of depression across time and the influence of family-level risk (family conflict, authoritative parenting style and parental substance use) and protective factors (parental involvement/monitoring and family support) on these patterns. These factors will be compared in terms of their strength of influence on depression. This predictive study is based on survey data collected from a randomly selected, ethnically diverse sample (n=149) of students from two Washington State school districts who were subsequently followed from middle into high school (8th-10th grade). The sample includes youth randomly assigned to the control condition in a school-based prevention study. Depression is expected to be positively associated with family risk factors and negatively associated with protective factors. We anticipate distinguishing differences in the relative influence of family factors on adolescent depression. This detailed examination of key factors influencing adolescent depression will contribute to designing new interventions that are more clearly and specifically targeted, and thus more meaningful, for vulnerable youth and their families.

Local health departments (LHDs) often do not routinely collect the type of data that can be used to conduct research and provide quality evidence-based feedback to inform public health policies and practice. To address the gap in evidence, we used new data from the Multi-Network Public Health Practice and Outcome Variation Examination (MPROVE) Study and explored processes for consolidating and presenting data for the usefulness of public health leaders’ development of policies, procedures, and services. The data from this study reflects the details of services provided by 35 LHDs across Washington State. In our research, we linked LHD data with data from existing sources and will present visual representations of the data for use by LHD leaders in examining variations and change in public health service provision. Services offered by the county were compared to other counties, trends in services across the state were analyzed, and health outcomes were compared to services provided on a county-by-county level. We specifically focused on public health service data relating to obesity, immunizations, and oral health. Through these comparisons we hope to identify further questions and gain insight on a variety of public health factors and their relation to LHD services provided. Through this process we hope to better understand how best to present data that helps LHD leaders (1) improve evidence-based public health policy; (2) modify procedures and services; (3) stimulate more effective and widespread data collection by LHDs; and (4) further improve the quality of research on public health department services.

Premature infants are at high risk for heat loss due to immature development. For these infants heat loss immediately following birth may be significant and transport from birthing area to the neonatal intensive care unit (NICU) further contributes to heat loss. The purpose of this study is to examine heat loss during transport from birthing area to the NICU. We accomplish this by gathering environmental temperature data as well information on types of transport and interventions used. This is a quantitative quality improvement study that is dealing with collection of observational and measured data. “Temperature collection data sheets” are filled out by nursing staff for NICU admissions that go through the Infant Stabilization Room (ISR). This sheet incorporates general background information about the infant (birth date, time, and gestation), the temperature of the infant in the ISR, the interventions used in the ISR and during transport and the temperature of the infant upon admission to the NICU. Environmental data are gathered using a QUESTemp 34 thermal monitor to record ambient and evaporative temperatures as well as relative humidity in the ISR and along the transport path to the NICU. These data are being analyzed using simple descriptive statistics to identify trends. This study will provide support for Evidence Based Practice that leads to recommendations for specific thermoregulation interventions and environmental set up of the NICU to better prevent and control hypothermia in premature infants.

Sleep disordered breathing (SDB) in children is a serious health concern associated with significant adverse health outcomes and high use of health care resources. It is characterized by habitual snoring and repeated episodes of partial or complete upper airway obstruction during sleep. In a recent study from our laboratory, 40% of a sample of school aged children with Juvenile Idiopathic Arthritis (JIA) showed signs of SDB. JIA is an inflammatory disease with no definite known cause and one of the most common rheumatologic chronic conditions in children. The purpose of this study is to examine SDB and neurobehavioral performance in 81 children (n=40 JIA) compared to a group of age, sex matched school age children. Children underwent one night of polysomnography in the UW School of Nursing Sleep Research Laboratory and completed neurocognitive tests (WASI, CANTAB). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF), an 86-item measure that assesses executive function behaviors at school and home. Data was analyzed using SPSS, and analyses were blocked into conceptual categories and then analyzed for group differences. Each category was considered a separate analysis with significance set at p <.05 (2-sided). The first set of analyses addressed group differences in all study variables between JIA and control children (using a Chi-square test). Second, we compared the proportion of children with SDB (apnea/hypopnea index >1.5/hr) as measured by polysomnography to those without SDB. Third, we examined relations among disease-related variables, sleep disordered breathing, and neurocognition (WASI, CANTAB, BRIEF), with a series of bivariate correlations controlling for age, medications, and disease condition. Finally, a linear regression analysis was performed to identify potential predictors of neurocognition (WASI, BRIEF, reaction time). We explored how much of the variance in neurocognition was explained by sleep disordered breathing, controlling for age, medications, and disease condition.

Pharmacogenetics is the field of biomedical science that studies how variation in a person’s genetic composition affects his or her response to drugs. Glucocorticoids are a group of signaling molecules that include endogenous hormones such as cortisol, which the body produces naturally in response to various forms of stress, as well as drugs with strong anti-inflammatory properties that are used to treat diseases ranging from asthma to cancer. The goal of this study was to identify correlations between interpersonal genetic variability and alterations in glucocorticoid receptor (GR)-mediated signaling. Salivary cortisol concentrations were measured in healthy volunteers (n=66) in order to determine differences in circulating cortisol concentrations and cortisol response following simulated physiological stress. Statistical analysis indicated inter-participant cortisol (CORT) variability was not correlated to participant demographics, health history, or single nucleotide polymorphisms (SNPs) in genes encoding the GR (NR3C1) or the essential GR chaperone protein hsp90 (HSP90AA1). Two participants with highly similar demographic profiles and opposing CORT responses (a matched pair) were selected for exome sequencing—the sequencing of all coding regions in the genome. A filtering algorithm identified candidate SNPs in approximately 30 genes involved in mediating the cortisol response and GR signaling. Interestingly, corticotropin releasing hormone receptor 1 (CRHR1) showed a difference of over 20 SNPs between the matched exome pair. CRHR1 regions were then sequenced from the larger participant group. Participants with average cortisol concentrations that slightly decreased following CORT stimulation most commonly exhibited a unique SNP profile—they shared many of the same SNPs in CRHR1. We speculate participants with SNP profiles associated with altered cortisol response may share a corresponding sensitivity to corticosteroid-based drug therapies.