We examined associations among 3 dimensions of sexual orientation (identity, attraction, and behavior) and sleep disturbance among young adults in the United States. Using Wave IV of the National Longitudinal Study of Adolescent Health (respondents aged 24–32, N = 14,334), we ran multivariate logistic regressions to estimate the probability of reporting trouble falling asleep, trouble staying asleep, and short sleep duration, based on specific sexual orientation categories.Results after controlling for mental health indicate that these categories are more likely to have trouble falling asleep: women who identify as “bisexual” (OR = 1.85, CI: 1.21,2.82), women attracted to “both sexes” (OR = 1.31, CI: 1.00,1.72), women who have had “mostly opposite sex” partners (OR = 1.40, CI: 1.10,1.77), and men who have had “mostly same sex” partners (OR = 2.28, CI: 1.21,4.31). For trouble staying asleep: women who identify as “bisexual” (OR = 1.48, CI: 1.01,2.18), men and women attracted to “both sexes” (OR = 1.81, CI: 1.12,2.91; OR = 1.27, CI: 1.00,1.60), and women who have had “mostly opposite sex partners” (OR = 1.38, CI: 1.13,1.69). For short sleep duration: women who identify as “mostly straight” or “mostly gay” (OR = 1.27, CI: 1.01,1.60; OR = 2.64, CI: 1.36,5.14), men who identify as “bisexual” (OR = 2.56, CI: 1.26,5.18), women attracted only to “same sex” (OR = 2.42, CI: 1.48,3.96), men attracted to “both sexes” (OR = 1.88, CI: 1.21,2.93), and women who have had “mostly same sex” partners (OR = 4.90, CI: 2.10,11.46). Given the variation in findings, it is necessary to analyze each sexual orientation dimension and the categories within each dimension to adequately understand sleep disturbances among sexual minority populations.
Background: The majority of adults in the United States fail to meet the Centers for Disease Control and Prevention (CDC) physical activity (PA) guideline recommendations for health promotion. Despite evidence of disparities by sexual orientation in adverse health outcomes related to PA, little is known about whether PA patterns and the likelihood of meeting these guidelines differ between heterosexual and sexual minority (SM) men and women. Methods: In 2018, we pooled unweighted respondent data from Kaiser Permanente Northern California Member Health Surveys conducted in 2008, 2011, and 2014/15 (N=42,534) to compare PA patterns among heterosexual and SM men and women. Results: In total, 38.8% of heterosexual men, 43.4% of SM men, 32.9% of heterosexual women, and 40.0% of SM women meet the CDC PA guidelines, yet there was no statistically significant difference in the adjusted odds of meeting these guidelines. Compared with heterosexual women, SM women engage in PA more frequently [odds ratio=0.81; 95% confidence interval (CI), 0.74–0.89], for more minutes per week on average (12.71; 95% CI, 4.85–20.57), and at higher levels of intensity (relative risk ratio=1.26; 95% CI, 1.02–1.56). Compared with heterosexual men, SM men engage in PA more frequently (OR=0.85; 95% CI, 0.74–0.98), for fewer minutes per week on average (−12.89; 95% CI, −25.84 to 0.06), and at lower levels of intensity (relative risk ratio=0.83; 95% CI, 0.67–0.99). Conclusions: We find that SMs get more frequent PA than their heterosexual peers, which suggests that the higher prevalence of obesity and other PA-related adverse health outcomes among SMs may be due to factors other than PA patterns.
BackgroundClinical guidelines recommend that parenteral nutrition (PN) is added to enteral nutrition (EN; supplemental parenteral nutrition (SPN)) in order to meet energy and protein needs in patients with cancer when EN alone is insufficient. However, although cancer-related malnutrition is common, there is poor awareness of the value of nutritional care, resulting in SPN being chronically underused.MethodsWe performed a targeted literature review and exploratory cost-utility analysis to gather evidence on the clinical effectiveness of SPN, and to estimate the potential cost-effectiveness of SPN versus EN alone in an example cancer setting.ResultsThe literature review identified studies linking SPN with malnutrition markers, and studies linking malnutrition markers with clinical outcomes. SPN was linked to improvements in body mass index (BMI), fat-free mass, phase angle (PhA) and prealbumin. Of these markers, BMI and PhA were strong predictors of survival. By combining published data, we generated indirect estimates of the overall survival HR associated with SPN; these ranged from 0.80 to 0.99 (mode 0.87). In patients with Stage IV inoperable pancreatic cancer, the incremental cost-effectiveness ratio versus EN alone was estimated to be £41 350 or £91 501 depending on whether nursing and home delivery costs for EN and SPN were combined or provided separately.ConclusionDespite a lack of direct evidence, the results of the literature review demonstrate that SPN may provide important clinical and quality of life benefits to patients with cancer. The potential for any improvement in outcomes in the modelled patient population is very limited, so cost-effectiveness may be greater in patients with less severe disease and other types of cancer.
Workplace violence in healthcare settings is alarmingly common and represents significant financial and human cost. The aim of this scoping review was to identify and summarize evidence on strategies to prevent and/or manage workplace violence in healthcare settings. Searches were limited to evidence-based clinical practice guidelines and systematic reviews published between 2015 and 2021. Multiple databases were searched and screened. Quality of the included guidelines and reviews was also assessed. Three guidelines and 33 systematic reviews were included. Both the Occupational Safety and Health Administration 2015 and Registered Nurses’ Association of Ontario 2019 guidelines provided useful recommendations for building a comprehensive prevention program. Evidence-based risk assessment, prevention and management, and education and training are all central components. Regular reassessment and adjustment is required. Included reviews ( n = 33) were grouped into five main categories: violence toward nurses ( n = 10); violence toward healthcare workers in general ( n = 8); violence in the emergency department ( n = 5); violence related to mental health ( n = 5); and measurement related to workplace violence ( n = 5). Multicomponent interventions were often more effective than those applied in isolation. We found consistent support for certain strategies including education and training, post-incident debriefing, multidisciplinary rapid response teams, and environmental modifications; however, the strength of evidence and certainty of conclusions were limited across reviews. This scoping review found that strong leadership that cultivates and enforces a culture of inclusivity, support, and respect is a prerequisite for a successful workplace violence prevention program. Rigorous comparative effectiveness research testing interventions are needed.
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