Digital Commons Network^™

Adverse Childhood Experiences As Individual Predictors Of Subjective Cognitive Decline: Analyzing The 2022 Behavioral Risk Factor Surveillance System, Ruthie Schmitt

Capstone Experience: Master of Public Health

Objectives. This study explored the association of Adverse Childhood Experiences (ACEs) and Subjective Cognitive Decline (SCD). This study aimed to determine within the United States which ACEs have a stronger association with SCD after 45 years of age by analyzing all 13 ACEs individually with SCD.

Methods. Data were obtained from the 2022 BRFSS. An analytic sample of 42,509 adults over 45 years of age from seven states was analyzed using binary and multivariate logistic regression. The outcome variable investigated in this study was SCD, and the explanatory variables were 13 ACEs.

Results. Of the respondents, 10.4% reported experiencing SCD …

Using Empowerment Theory To Improve Understanding Of Type 2 Diabetes Mellitus In Haitian American Women, Balkys Bivins, Brenda Owusu, Indra R Hershorin, Tony Umadhay, Janet Joseph, Arvinder Singh

Nursing & Health Sciences Research Journal

Introduction: The CDC (2020) revealed that the age-adjusted prevalence of diabetes mellitus in the United States among the Black, non-Hispanic population is 16.8%. A study conducted by Bivins et al. (2021) revealed a 39% prevalence of type 2 diabetes mellitus (T2DM) among Haitian Americans (HAs) living in several states. In the literature, HAs are often grouped with Black Americans, yet Haitian American women (HAW) have unique struggles with treatment and management of T2DM. No prior study used the empowerment theory to improve the management of T2DM in HAW. Purpose: To improve the understanding of T2DM in HAW using empowerment theory. …

The Use Of Deception In Dementia-Care Robots: Should Robots Tell "White Lies" To Limit Emotional Distress?, Samuel R. Cox, Grace Cheong, Wei Tsang Ooi

ROSA Journal Articles and Publications

With projections of ageing populations and increasing rates of dementia, there is need for professional caregivers. Assistive robots have been proposed as a solution to this, as they can assist people both physically and socially. However, caregivers often need to use acts of deception (such as misdirection or white lies) in order to ensure necessary care is provided while limiting negative impacts on the cared-for such as emotional distress or loss of dignity. We discuss such use of deception, and contextualise their use within robotics.

A Latent Variable Approach To Assess Dementia In Mexico And The United States: Measurement Invariance And Validation, Joseph Saenz, Christopher Beam, Silvia Mejia-Arango

School of Medicine Publications

Latent dementia indices (LDI) use cognitive and functional data to approximate dementia. Few evaluate the LDI’s utility in cross-national work. This study tests metric measurement invariance of an LDI in the United States and Mexico and evaluates its validity in Mexico. Data included the United States Harmonized Cognitive Assessment Protocol (HCAP, n=3,267), MexCog (n=2,042), and a Mexican clinical validation sample with diagnosed cognitive status (51 cognitively normal, 49 mild cognitive impairment (MCI), and 50 dementia) who received the MexCog battery. The LDI was measured using highly comparable items (13 cognitive and 10 functional). We tested metric measurement invariance of the …

Project: Mhealth Applications For Educating Community Nurses, Nkemdilim Stacy Egbo

Electronic Theses and Dissertations

Hypertension is a chronic health condition linked to high morbidity and mortality rates in America and around the world. Hypertension care in developing and underdeveloped countries requires quick intervention. The proliferation of smart technologies and mobile health applications offer some leverage for the alternative management of hypertension, but evidence related to effectiveness in Nigeria are limited. The purpose of the study was to assess the impact of m-Health apps on hypertension self-management through nurses’ education in Southern region of Nigeria, as well as their self-confidence or efficacy using the Hypertension Evaluation of Lifestyle Management assessment. A quasi-experimental pretest-posttest design was …

Greater Socioenvironmental Risk Factors And Higher Chronic Pain Stage Are Associated With Thinner Bilateral Temporal Lobes, Lisa H Antoine, Burel R Goodin, Et Al.

2020-Current year OA Pubs

INTRODUCTION: Previous research indicates ethnic/race group differences in pain and neurodegenerative diseases. Accounting for socioenvironmental factors reduces ethnic/race group differences in clinical and experimental pain. In the current study sample, we previously reported that in individuals with knee pain, ethnic/race group differences were observed in bilateral temporal lobe thickness, areas of the brain associated with risk for Alzheimer's disease, and related dementias. The purpose of the study was to determine if socioenvironmental factors reduce or account for previously observed ethnic/race group differences and explore if a combined effect of socioenvironmental risk and chronic pain severity on temporal lobe cortices is …

Prostate Safety Events During Testosterone Replacement Therapy In Men With Hypogonadism: A Randomized Clinical Trial, Shalender Bhasin, Thomas G Travison, Karol M Pencina, Michael O'Leary, Glenn R Cunningham, A Michael Lincoff, Steven E Nissen, M Scott Lucia, Mark A Preston, Mohit Khera, Nader Khan, Michael C Snabes, Xue Li, Catherine M Tangen, Kevin A Buhr, Ian M Thompson

Faculty, Staff and Students Publications

IMPORTANCE: The effect of testosterone replacement therapy (TRT) on the risk of prostate cancer and other adverse prostate events is unknown.

OBJECTIVE: To compare the effect of TRT vs placebo on the incidences of high-grade prostate cancers (Gleason score ≥4 + 3), any prostate cancer, acute urinary retention, invasive prostate procedures, and pharmacologic treatment for lower urinary tract symptoms in men with hypogonadism.

DESIGN, SETTING, AND PARTICIPANTS: This placebo-controlled, double-blind randomized clinical trial enrolled 5246 men (aged 45-80 years) from 316 US trial sites who had 2 testosterone concentrations less than 300 ng/dL, hypogonadal symptoms, and cardiovascular disease (CVD) or …

Factors Associated With Depressive Symptoms Among Community-Dwelling Older People In East-Coast Malaysia, Siti Suhana Zakaria, Siti Nur Illiani Jaafar, Muhammad Kamil Che Hasan, Nik Noor Kaussar Nik Mohd Hatta, Wan Nor Aliza Wan Abdul Rahman

Jurnal Keperawatan Indonesia

Older people are increasing in number globally, and they are likely to have mental health problems, including de- pression. In this population, the risk of having depressive symptoms is very high due to multidimensional factors, but these symptoms are often undertreated. This study aimed to determine the prevalence and associated factors of de- pressive symptoms among community-dwelling older people living on the East Coast of Malaysia. A cross-sectional study was conducted in several areas of the state of Terengganu based on multilayered stratified sampling. A total of 240 participants were randomly selected. Several instruments were employed, such as the Geriatric …

Early Discharge Planning To Improve Throughput, Alan Chhith

Student Scholarly Projects

Early discharge planning can improve the safety and outcomes of hospitalized patients. The aim of the multidisciplinary team early discharge rounds was to manage patient flow by removing discharge barriers to reduce the length of stay in the medical/surgical unit. The overall goal of the process improvement project was to make inpatient beds available to admit patients from the emergency department, reducing long ED boarding, and decrease the hours of diversion. The PICOT question for this project was: in the Veteran population (P) in the VA medical/surgical unit, early discharge planning with an interdisciplinary team (I) compared to regular discharge …

Assessing Medication Self-Management Challenges And Self-Efficacy During Emergency Department Medication Reconciliation: An Evidence-Based Quality Improvement Project, Mitchel Erickson, Jyu-Lin Chen, Yoonmee Joo, Stephanie Rogers, Thomas Hoffman, Claire Bainbridge

Journal of Geriatric Emergency Medicine

Abstract

Background

Older adult patients (≥65) accessing emergency departments (ED) represent a significant demographic. Recidivism secondary to adverse drug events (ADE) ranges between 6-24% and levels of prescribed medication non-adherence is common among older adults. The ED pharmacist medication reconciliation workflow may mitigate self-management challenges in real time and reduce medication-related harm while potentially impacting recidivism, medication adherence, and patient self-efficacy. The purposes of this evidence-based project were to (1) evaluate the impact of a modified Medication Management for Deficiencies in the Elderly (MedMalDE) intervention on Self-Efficacy for Appropriate Medication Use (SEAMS) and 30-day return to care and (2) identify …

Supporting Novice Nurse Transition To Practice Through Mentorship, Jesssica M. Cox

Walden Dissertations and Doctoral Studies

No abstract provided.

Association Between Microbiome And The Development Of Adverse Posttraumatic Neuropsychiatric Sequelae After Traumatic Stress Exposure, Abigail L Zeamer, Stacey L House, Et Al.

2020-Current year OA Pubs

Patients exposed to trauma often experience high rates of adverse post-traumatic neuropsychiatric sequelae (APNS). The biological mechanisms promoting APNS are currently unknown, but the microbiota-gut-brain axis offers an avenue to understanding mechanisms as well as possibilities for intervention. Microbiome composition after trauma exposure has been poorly examined regarding neuropsychiatric outcomes. We aimed to determine whether the gut microbiomes of trauma-exposed emergency department patients who develop APNS have dysfunctional gut microbiome profiles and discover potential associated mechanisms. We performed metagenomic analysis on stool samples (n = 51) from a subset of adults enrolled in the Advancing Understanding of RecOvery afteR traumA …

Targeting Loneliness In Older Adults With Weekly Socialization, Tanja Johnson

Dissertations

Problem: Loneliness related to social isolation among the older adult population has become an increasing health concern with few interventions available for the general population. Loneliness has been directly associated with depression, poorer physical health outcomes, and overall quality of life.

Methods: The purpose of this study is to evaluate loneliness in the older adult population residing in a senior living community in an urban area in Missouri. Weekly one-on-one socialization, ranging from 45-60 minutes, will be implemented over 6 weeks, with pre and post-intervention screening for loneliness with the 28-item Visit-A-Bit (VAB) screening tool. Approval was received by both …

Social Activity Restriction And Psychological Health Among Caregivers Of Older Adults With And Without Dementia, Elliane Irani, Kylie Meyer, Scott Emory Moore, Kedong Ding

Faculty Scholarship

Objectives: We examined associations between social activity restriction and psychological distress and well-being for caregivers of older adults with and without dementia, and if the identified associations are different for the two groups. Methods: Using data from the 2017 National Study of Caregiving, we identified caregivers of older adults with (N = 541) and without (N = 1701) dementia. Linear regression models were estimated, adjusting for caregivers’ age, gender, race, education, relationship to care recipient, and self-rated health. Results: Restriction in visiting friends and family and attending religious services were associated with higher distress in dementia caregivers. Restriction in visiting …

Implementing Health Information Stations At Addiction Recovery Center, Esther Yi, Daryn Hernandez, Maryam Umer, Jasmine Alvarez, Kaitlyn Ward, Riciajoy Padilla

Nursing Leadership in Community Engagement Projects

Implementing Health Information Stations at the Addiction Recovery Center

Six Seattle Pacific University nursing students partnered with an addiction recovery center to address aging healthcare concerns. The recovery center is a non-profit organization that provides a refuge for healing for community members recovering from trauma, homelessness, addiction, and other mental health challenges. Through our weekly meetings with the community, we wanted to address specific barriers such as aging healthcare concerns. We focused on how the low-income aging population posed barriers to aging well.

Background

There has also been a rise in poverty in aging populations (Saldanha, 2023). Though aging influences …

Relationship Of Race With Functional And Clinical Outcomes With The Rehab-Hf Multidomain Physical Rehabilitation Intervention For Older Patients With Acute Heart Failure, Olivia N. Gilbert, Robert J. Mentz, Alain G. Bertoni, Dalane W. Kitzman, David J. Whellan, Gordon R. Reeves, Pamela W. Duncan, Michael Benjamin Nelson, Vanessa Blumer, Haiying Chen, Shelby D. Reed, Bharathi Upadhya, Christopher M. O'Connor, Amy M. Pastva

Department of Medicine Faculty Papers

Background

The REHAB‐HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) randomized trial demonstrated that a 3‐month transitional, tailored, progressive, multidomain physical rehabilitation intervention improves physical function, frailty, depression, and health‐related quality of life among older adults with acute decompensated heart failure. Whether there is differential intervention efficacy by race is unknown.

Methods and Results

In this prespecified analysis, differential intervention effects by race were explored at 3 months for physical function (Short Physical Performance Battery [primary outcome], 6‐Minute Walk Distance), cognition, depression, frailty, health‐related quality of life (Kansas City Cardiomyopathy Questionnaire, EuroQoL 5‐Dimension‐5‐Level Questionnaire) and at 6 months for …

The Effect Of Obesity On Comorbidities: A Benchmark Study, Kaley Nolen

MSN Capstone Projects

Obesity is distinguished by a body mass index (BMI) greater than 30. Tremmel et al. (2017) reports obese individuals are at a greater risk for developing cardiovascular disease, diabetes, and cancer. In 2014, approximately 641 million adults were classified as obese (Zhang et al., 2018). This epidemic has drastically worsened over the last two decades resulting in obesity ranking as the fifth most common cause of death globally (Safaei et al., 2021). Okunogbe et al. (2021) states, slowing the incidence rate of obesity by 5% will save approximately $3.3 billion annually between 2020-2060. The pathophysiology and cause of obesity is …

Multimodal Analysis Of Secondary Cerebellar Alterations After Pediatric Traumatic Brain Injury, Finian Keleher, Hannah M Lindsey, Rebecca Kerestes, Houshang Amiri, Robert F Asarnow, Talin Babikian, Brenda Bartnik-Olson, Erin D Bigler, Karen Caeyenberghs, Carrie Esopenko, Linda Ewing-Cobbs, Christopher C Giza, Naomi J Goodrich-Hunsaker, Cooper B Hodges, Kristen R Hoskinson, Andrei Irimia, Marsh Königs, Jeffrey E Max, Mary R Newsome, Alexander Olsen, Nicholas P Ryan, Adam T Schmidt, Dan J Stein, Stacy J Suskauer, Ashley L Ware, Anne L Wheeler, Brandon A Zielinski, Paul M Thompson, Ian H Harding, David F Tate, Elisabeth A Wilde, Emily L Dennis

Faculty, Staff and Student Publications

Importance: Traumatic brain injury (TBI) is known to cause widespread neural disruption in the cerebrum. However, less is known about the association of TBI with cerebellar structure and how such changes may alter executive functioning.

Objective: To investigate alterations in subregional cerebellum volume and cerebral white matter microstructure after pediatric TBI and examine subsequent changes in executive function.

Design, setting, and participants: This retrospective cohort study combined 12 data sets (collected between 2006 and 2020) from 9 sites in the Enhancing Neuroimaging Genetics Through Meta-Analysis Consortium Pediatric TBI working group in a mega-analysis of cerebellar structure. Participants with TBI or …

Economic Equity And People With Disabilities: Development And Characterization Of A Novel Index, Bhavneet Walia, Katherine Mcdonald, Joy Hammel, Lex Frieden, Michael Morris, Barry Whaley, Vinh Nguyen

Faculty, Staff and Student Publications

Here we develop two new social indices: The ADA PARC Absolute Economic Opportunity Index and the ADA PARC Relative Economic Opportunity Index. These indices allow us novel examinations of economic equity between people with and without disabilities within a U.S. State and between people with disabilities in different states using aggregations of multiple component economic indicators. These represent the first efforts to offer U.S. indices of this focus, an important development given the distinct economic needs of people with disabilities and the value in accounting for distinct national policies. The indices rely on U.S. Census and other data on economic …

Psychological Safety And Conflict Management Among Nurse Practitioners In Interprofessional Teams, Scott Tyler Faust

Electronic Theses and Dissertations

This quantitative correlational study explored the relationships between perceived psychological safety, conflict management styles, and perceived conflict management success among nurse practitioners (NPs) operating in interprofessional acute or critical care teams in the United States. Despite existing literature on conflict management and psychological safety, there is a noticeable gap concerning the interplay of these factors, specifically among NPs. A multi-item survey was developed from validated measures to assess psychological safety, conflict management success, and conflict management style. The final sample included 944 NPs. The findings revealed a statistically significant difference in the scores of perceived psychological safety, depending on the …

Recent Developments In Frailty Identification, Management, Risk Factors And Prevention: A Narrative Review Of Leading Journals In Geriatrics And Gerontology, Elsa Dent, Peter Hanlon, Marc Sim, Juulia Jylhävä, Zuyun Liu, Davide L. Vetrano, Erwin Stolz, Mario U. Pérez-Zepeda, Daniel R. Crabtree, Caroline Nicholson, Jenny Job, Rachel C. Ambagtsheer, Paul R. Ward, Sandra M. Shi, Quan Huynh, Emiel O. Hoogendijk

Research outputs 2022 to 2026

Frailty is an age-related clinical condition characterised by an increased susceptibility to stressors and an elevated risk of adverse outcomes such as mortality. In the light of global population ageing, the prevalence of frailty is expected to soar in coming decades. This narrative review provides critical insights into recent developments and emerging practices in frailty research regarding identification, management, risk factors, and prevention. We searched journals in the top two quartiles of geriatrics and gerontology (from Clarivate Journal Citation Reports) for articles published between 01 January 2018 and 20 December 2022. Several recent developments were identified, including new biomarkers and …

Web-Based Presence For Social Connectedness In Long-Term Care: Protocol For A Qualitative Multimethods Study, Anna Garnett, Halyna Yurkiv, Richard Booth, Denise Connelly, Lorie Donelle Phd, Rn, Fcan

Publications

BACKGROUND: The COVID-19 pandemic and resultant restrictions on social gatherings significantly impacted many peoples' sense of social connectedness, defined as an individual's subjective sense of having close relationships with others. Older adults living in long-term care homes (LTCHs) experienced extreme restrictions on social gatherings, which negatively impacted their physical and mental health as well as the health and well-being of their family caregivers. Their experiences highlighted the need to reconceptualize social connectedness. In particular, the pandemic highlighted the need to explore novel ways to attain fulfilling relationships with others in the absence of physical gatherings such as through the use …

Recurrent Lower Urinary Tract Infections: More Than An Infection For Older Women, Sencer Gani̇dağli, Ercüment Öztürk, Zeynel Abi̇di̇n Öztürk

Turkish Journal of Medical Sciences

Background/aim: Older adults tend to have more urinary tract infections (UTIs). The frequency of recurrent lower urinary tract infections (rLUTIs) increases with age. rLUTIs are associated with long-term chronic effects on geriatric syndromes in older adults. We aimed to investigate possible risk factors that influence rLUTIs in older adults based on comprehensive geriatric assessment (CGA). Materials and methods: This cross-sectional study included 235 older adults admitted to Gaziantep University?s Geriatric Outpatient Clinic between June 1 and November 30, 2022. All patients underwent CGA. The Geriatric Depression Scale (GDS), the European Quality of Life-Five Dimension (EQ-5D) questionnaire, the Pittsburgh Sleep Quality …

Effects Of Progressive Functional Ankle Exercises In Spastic Cerebral Palsy, Plantarflexors Versus Dorsiflexors: A Randomized Trial, Melek Volkan Yazici, Gamze Çobanoğlu, Gökhan Yazici, Bülent Elbasan

Turkish Journal of Medical Sciences

Background/aim: Children with cerebral palsy (CP), even those who have very mild impairment, have lower muscle strength than their typically developing peers. The ankle dorsiflexors (DFs) and plantarflexors (PFs) of children with CP are especially weak. Weakness in the ankle muscles causes problems in functional skills, mobility, and balance in spastic CP (SCP). The aim of this study was to investigate the effects of progressive functional exercises (PFEs) on the DF, PF, or dorsi-plantar flexor (DPF) muscles in children with SCP, specifically, the functional mobility, balance, and maximum voluntary contraction (MVC), and compare the effects of strengthening these muscles individually …

Correlation Of Metal Ions With Specific Brain Region Volumes In Neurodegenerative Diseases, İsmet Murat Melek, Berna Kuş, Zülal Kaptan, Emi̇ne Petekkaya

Turkish Journal of Medical Sciences

Background/aim: There are reports stating that deteriorations in metal homeostasis in neurodegenerative diseases promote abnormal protein accumulation. In this study, the serum metal levels in Alzheimer?s disease (AD) and Parkinson?s disease (PD) and its relationship with the cortical regions of the brain were investigated. Materials and methods: The patients were divided into 3 groups consisting of the AD group, PD group, and healthy control group (n = 15 for each). The volumes of specific brain regions were measured over the participants? 3-dimensional magnetic resonance images, and they were compared across the groups. Copper, zinc, iron, and ferritin levels in the …

Tuberculosis Presentation And Outcomes In Older Hispanic Adults From Tamaulipas, Mexico, Belinda Medrano, Miryoung Lee, Gretchen L. Gemeinhardt, Javier E. Rodríguez-Herrera, Moncerrato García-Viveros, Blanca I. Restrepo

School of Medicine Publications

Older people are at high risk of developing and dying from pulmonary infections like tuberculosis (TB), but there are few studies among them, particularly in Hispanics. To address these gaps, we sought to identify host factors associated with TB and adverse treatment outcomes in older Hispanics by conducting a cross-sectional study of TB surveillance data from Tamaulipas, Mexico (2006–2013; n = 8381). Multivariable logistic regressions were assessed for older adults (OA ≥65 years) when compared to young (YA, 18–39 years) and middle-aged adults (40–64 years). We found that the OA had features associated with a less complicated TB (e.g., lower …

A Scoping Review Of Nutrition Health For Older Adults: Does Technology Help?, Dara L. Lobuono, Michael Milovich Jr.

Rita & Larry Salva School of Nursing and Health Professions Departmental Research

The technological developments in healthcare may help facilitate older adult nutritional care. This scoping review includes research in technology and nutrition to (1) explain how technology is used to manage nutrition needs and (2) describe the forms of technology used to manage nutrition. Five major databases were the foundation for papers published from January 2000 to December 2020. The most common type of technology used is software to (1) “track, plan, and execute” nutrition management and for (2) “assessing” technology use. “Track, plan, and execute” includes tracking food intake, planning for changes, and executing a plan. “Assessing” technology use is …

Depression By Gender And Associated Factors Among Older Adults In India: Implications For Age-Friendly Policies, Ronak Paul, T. Muhammad, Rashmi Rashmi, Palak Sharma, Shobhit Srivastava, Preeti Zanwar

College of Population Health Faculty Papers

Inspite of implementing policies to control mental health problems, depression remains a severe health concern among older adults in India. We examined self-reported differences in the depression among older men and women in India and examined associated factors for gender differences in depression at the population level. We utilized nationally representative data from the Longitudinal Aging Study in India (LASI) wave I, for years 2017-2019. Our analytical sample comprised of 30,637 older adults ages 60 years and above (14,682 men and 15,655 women). We conducted descriptive statistics and Chi-Square tests followed by binary logistic regression and multivariate decomposition analyses to …

Association Between Whole Blood-Derived Mitochondrial Dna Copy Number, Low-Density Lipoprotein Cholesterol, And Cardiovascular Disease Risk, Xue Liu, Xianbang Sun, Yuankai Zhang, Wenqing Jiang, Meng Lai, Kerri L Wiggins, Laura M Raffield, Lawrence F Bielak, Wei Zhao, Achilleas Pitsillides, Jeffrey Haessler, Yinan Zheng, Thomas W Blackwell, Jie Yao, Xiuqing Guo, Yong Qian, Bharat Thyagarajan, Nathan Pankratz, Stephen S Rich, Kent D Taylor, Patricia A Peyser, Susan R Heckbert, Sudha Seshadri, Eric Boerwinkle, Megan L Grove, Nicholas B Larson, Jennifer A Smith, Ramachandran S Vasan, Annette L Fitzpatrick, Myriam Fornage, Jun Ding, April P Carson, Goncalo Abecasis, Josée Dupuis, Alexander Reiner, Charles Kooperberg, Lifang Hou, Bruce M Psaty, James G Wilson, Daniel Levy, Jerome I Rotter, Joshua C Bis, Claudia L Satizabal, Dan E Arking, Chunyu Liu

Faculty, Staff and Student Publications

Background The relationship between mitochondrial DNA copy number (mtDNA CN) and cardiovascular disease remains elusive. Methods and Results We performed cross-sectional and prospective association analyses of blood-derived mtDNA CN and cardiovascular disease outcomes in 27 316 participants in 8 cohorts of multiple racial and ethnic groups with whole-genome sequencing. We also performed Mendelian randomization to explore causal relationships of mtDNA CN with coronary heart disease (CHD) and cardiometabolic risk factors (obesity, diabetes, hypertension, and hyperlipidemia).

The Effects Of Mindfulness On Depression In Dialysis Patients, Nakeia Saddler

Dissertations

Abstract

Problem: Depression is a prevailing global health issue and a typical complication of dialysis patients. This quality improvement project's purpose was to evaluate mindfulness on depression in dialysis patients, aged 18-93, who are on dialysis and participated in a mindfulness program over three months.

Methods: A descriptive, prospective, and retrospective design was used to assess depression pre- and post-implementation of a mindfulness telephone line over three months. A convenience sample of twenty adults aged 18-83 who use this hemodialysis center on Monday, Wednesday, and Friday was utilized. The Iowa Model is the framework selected to guide the implementation of …