RESUMEN
An environmental risk factor for substance abuse and dependence is childhood sexual abuse (CSA). We piloted an approach we developed to test the hypothesis that hypothalamic-pituitary-adrenal (HPA) axis dysregulation from the stress of CSA is a biological mediator. We based our hypothesis on the allostasis model. New admissions to residential treatment for substance use disorders (N = 41) were evaluated for CSA history and two HPA axis regulation measures at baseline, one month, and two months. The two HPA axis regulation measures were morning cortisol level and the dexamethasone suppression test. Five potential covariates were also measured to increase reliability of the findings. Feasibility outcomes were mostly favorable, and included rates of participation (57 %), attrition (46 % at one month and 71 % at two months), and compliance with data collection procedures (87 % for morning cortisol level and 84 % for the dexamethasone suppression test). High attrition rates at one and two months were entirely attributable to high rates of leaving treatment, an important consideration for future studies. Baseline correlations among variables showed a significant negative correlation between dexamethasone suppression and perceived stress, a potential covariate (rho = -0.458). This finding suggests that individuals with lower stress levels have better negative feedback regulation of the HPA axis, which results in the benefit of lower cortisol exposure-a finding congruent with the allostasis model.
Asunto(s)
Delitos Sexuales , Trastornos Relacionados con Sustancias , Humanos , Sistema Hipotálamo-Hipofisario , Hidrocortisona , Sistema Hipófiso-Suprarrenal , Reproducibilidad de los Resultados , DexametasonaRESUMEN
BACKGROUND: Bariatric surgery patients who report physical or sexual abuse form a sizeable cohort that stands out due to psychological comorbidity. Their possible vulnerability to suboptimal weight loss remains of interest. Their risk for malnutrition due to inadequate oral intake following surgery is underexplored. OBJECTIVES: Study aims were to determine the effect of self-reported physical or sexual abuse in patients undergoing open biliopancreatic diversion with duodenal switch (BPD/DS) on (a) 3-year weight loss trajectories and (b) timing of feeding jejunostomy tube (J tube) removal. Delayed J tube removal served as an indicator for inadequate oral intake. METHODS: In this retrospective cohort study, the sample (N = 189) consisted of all patients who underwent primary BPD/DS by the same surgeon during 2009 and 2010 at a Midwestern health system. All patients had a J tube placed during surgery. Longitudinal mixed models were used for testing differences in weight loss trajectories by abuse status. RESULTS: There were no significant differences in weight loss trajectories by abuse status. The abused group had the J tube in place a mean of 61.9 days (SD = 39.5) compared to 44.8 days (SD = 32.8) for the not abused group, a significant difference. CONCLUSIONS: Our use of the best available statistical methods lends validity to previous findings that suggest physical or sexual abuse does not affect weight loss after bariatric surgery. Increased likelihood of persistent inadequate oral intake in the abused group suggests the need for early multidisciplinary interventions that include mental health and nutrition experts.
Asunto(s)
Cirugía Bariátrica , Desviación Biliopancreática , Obesidad Mórbida , Delitos Sexuales , Pérdida de Peso , Adulto , Anastomosis Quirúrgica , Desviación Biliopancreática/métodos , Comorbilidad , Femenino , Humanos , Intestinos/cirugía , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Estado Nutricional , Obesidad Mórbida/cirugía , Examen Físico , Complicaciones Posoperatorias/epidemiología , Estudios RetrospectivosRESUMEN
OBJECTIVES: Health systems face resource and time barriers to developing and implementing cancer survivorship care plans (SCPs) when active cancer treatment is completed. To address this problem, the South Dakota (SD) Department of Health partnered with two of SD's largest health systems to create the SD Survivorship Program. The purpose of this program evaluation study was to describe and compare SCP development and implementation at the two health systems. DESIGN & SAMPLE: A descriptive qualitative design was used. Interview participants were instrumental in the development and implementation of SCPs within their respective health system. MEASURES: Content analysis was used to analyze the interview data. RESULTS: The two health systems used similar processes for (a) early designation of program personnel, (b) developing SCP templates, (c) provider/staff input, and (d) identifying/tracking eligible patients. In contrast, they developed differing processes for SCP completion and delivery. The two health systems also identified effective strategies and challenges in SCP development and implementation. CONCLUSION: This evaluation suggests that partnerships between state health departments and local health systems could be key for meeting the nation-wide goal of universal SCP implementation. Particularly, other low-population rural states like SD can use the findings to help build their SCP programs.
Asunto(s)
Continuidad de la Atención al Paciente , Atención a la Salud/métodos , Neoplasias/terapia , Planificación de Atención al Paciente , Encuestas y Cuestionarios , Femenino , Programas de Gobierno , Recursos en Salud , Humanos , Población Rural , South Dakota , Agencias Estatales de Desarrollo y Planificación de la Salud , Sobrevivientes , Supervivencia , Estados UnidosRESUMEN
Despite evidence of the benefits of preconception health care (PCHC), little is known about awareness and access to PCHC for rural, reproductive-aged women. This study aimed to assess the prevalence of PCHC conversations between rural reproductive-age women and health care providers, PCHC interventions received in the past year, and ascertain predictors of PCHC conversations and interventions. Women (n = 868; 18-45 years) completed a questionnaire including reproductive history, health care services utilization, and interest in PCHC. The prevalence of health care providers' PCHC conversations was 53.9 %, and the mean number of interventions reported was 2.6 ± 2.7 (±SD). Significant predictors of PCHC conversation based on adjusted odds ratios from logistic regression were race (Native American 76 % greater than White), health care provider type (non-physician 63 % greater than physician), visits to a health care provider (3+ times 32 % greater than 1-2 times), and pregnancy planning (considering in next 1-5 years 51 % greater than no plans). Significant predictors of PCHC interventions received in the past 12 months based on adjusted risk ratios from negative binomial regression were race (Native American 22 % greater than White), PCHC conversation with a health care provider (yes 52 % lower than no), reporting PCHC as beneficial (yes 32 % greater than don't know), and visits to a health care provider in the past year (3+ times 90 % greater than 1-2 times). Increasing conversations about PCHC between health care providers and their reproductive-aged patients can improve awareness and increase their likelihood of receiving all of the recommended interventions.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Atención Preconceptiva , Población Rural/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , South Dakota/epidemiología , Adulto JovenRESUMEN
BACKGROUND: This article describes the development, implementation, and outcomes of an integrated family nurse practitioner/psychiatric-mental health nurse practitioner (FNP/PMH-NP) program. The program was designed to help alleviate health professional shortages in rural areas. METHOD: Faculty from both specialties developed a 3-year integrated curriculum, with attention to course sequencing and removing redundancies. Students completed all FNP and PMH-NP specialty courses and 855 clinical hours. Specialty integration occurred during the final semester through faculty-facilitated integrated case studies and clinical preceptorships with dual-certified rural nurse practitioners. RESULTS: Thirteen students completed the program between 2006 and 2014. A survey of graduates (75% response rate) demonstrated that most were dual certified, and less than half practiced in rural areas. All were very satisfied with their nurse practitioner role. CONCLUSION: The program successfully prepared graduates to care for patients across the mind-body spectrum in integrated mental health-primary care positions. More work may be needed to market the integrated role and rural practice.
Asunto(s)
Enfermería de la Familia/educación , Enfermeras Practicantes/educación , Enfermería Psiquiátrica/educación , Curriculum , Educación en Enfermería/tendencias , Evaluación Educacional , Humanos , Modelos Educacionales , Investigación en Educación de Enfermería , Preceptoría , Desarrollo de Programa , Evaluación de Programas y Proyectos de SaludRESUMEN
Childhood sexual abuse increases risk for adult obesity. A potential contributing factor is altered cortisol secretion. In this pilot study, relationships among childhood sexual abuse, diurnal salivary cortisol secretion, and weight loss were explored in 17 bariatric surgery patients. Measurement points were before surgery (baseline) and 3 and 6 months after surgery. Childhood sexual abuse was measured by the Childhood Trauma Questionnaire. The results showed moderate but nonsignificant positive correlations between the childhood sexual abuse subscale score and baseline morning cortisol, evening cortisol, and daily mean cortisol. An unexpected positive correlation was noted between the Childhood Trauma Questionnaire total score and weight loss at six months. Diurnal cortisol secretion did not change over time after surgery nor correlate significantly with weight loss at six months.
Asunto(s)
Hidrocortisona/análisis , Obesidad/metabolismo , Saliva/metabolismo , Maltrato Conyugal/psicología , Pérdida de Peso/fisiología , Adulto , Biomarcadores/análisis , Niño , Femenino , Derivación Gástrica , Humanos , Masculino , Obesidad/cirugía , Proyectos Piloto , Resultado del TratamientoRESUMEN
One prevention strategy for childhood sexual abuse (CSA) involves educational programs delivered to children in the school environment. The purpose of this integrative literature review was to determine the state of the science on school-based CSA prevention programs. The authors extracted data from 26 articles that fit inclusion criteria to answer research questions on types of programs, methods used to evaluate programs, and program success. Analysis of the extracted data led to the identification of seven categories of teaching learning content. Delivery methods included films, plays, discussion, and role play. Most authors used an untreated or placebo control group pretest/posttest design for evaluation. According to the child outcome measures chosen, the majority of programs were successful. The review also found school nurses rarely involved in these programs. Although not a traditional aspect of their responsibilities, information from this review can help school nurses implement a school-based CSA prevention program.
Asunto(s)
Abuso Sexual Infantil/prevención & control , Evaluación de Programas y Proyectos de Salud , Servicios de Salud Escolar , Niño , HumanosRESUMEN
A convenience sample of 38 civilly committed sex offenders completed questionnaires on selected psychosocial and developmental characteristics. More than half (61%) demonstrated an external locus of control. They had higher levels of empathy compared to normative data for the general population, and their levels of anger, aggression, and hostility were similar to male college students. Somatization was comparable to psychiatric outpatients. A high proportion reported at least one form of childhood trauma (87%), with 66% reporting childhood sexual abuse. Issues related to the use of self-report instruments with this patient population are discussed and recommendations for future studies are suggested.
Asunto(s)
Abuso Sexual Infantil/psicología , Internamiento Obligatorio del Enfermo Mental , Acontecimientos que Cambian la Vida , Prisioneros/psicología , Delitos Sexuales/psicología , Adulto , Anciano , Agresión/psicología , Ira , Niño , Abuso Sexual Infantil/legislación & jurisprudencia , Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Empatía , Hospitales Psiquiátricos , Hospitales Provinciales , Hostilidad , Humanos , Control Interno-Externo , Masculino , Persona de Mediana Edad , Pedofilia/enfermería , Pedofilia/psicología , Inventario de Personalidad/estadística & datos numéricos , Psicometría/estadística & datos numéricos , Valores de Referencia , Factores de Riesgo , Delitos Sexuales/legislación & jurisprudencia , Adulto JovenRESUMEN
BACKGROUND: Knowledge of the diurnal cortisol response to acute stress in healthy individuals can help us better understand the physiological and health effects of chronic stress. OBJECTIVE: To compare the diurnal patterns of cortisol secretion of 15 medical students 2 weeks before a major written examination (control phase) and 2 weeks later at the time of the examination (acute stress phase). DESIGN: Interrupted time series within-subjects. RESULTS: During the acute stress phase, less cortisol was secreted over the course of the day, as demonstrated by a more prolonged and steeper decline in cortisol levels. In addition, higher cortisol levels were present in the evening. Despite these changes in the usual diurnal pattern, overall exposure to cortisol remained the same for both phases. CONCLUSIONS: The results of this study suggest that specific adaptations to the diurnal pattern of cortisol are made in the face of acute stress, important information for understanding cortisol regulation in health and illness.
Asunto(s)
Ritmo Circadiano/fisiología , Hidrocortisona/metabolismo , Saliva/metabolismo , Estrés Psicológico/metabolismo , Estudiantes/psicología , Adulto , Femenino , Humanos , Masculino , Estrés Psicológico/psicología , Factores de Tiempo , Adulto JovenRESUMEN
Adults who experienced childhood sexual abuse (CSA) are at increased risk for major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Animal studies suggest that dysregulated biological stress systems are a potential mechanism, but there are multiple challenges involved in conducting translational studies in humans. The purpose of this integrative literature review was to determine the state of the science of hypothalamic-pituitary-adrenal (HPA) axis regulation in adults who experienced CSA, with a focus on the health outcomes of MDD and PTSD. A variety of methods for HPA axis measurement were used in the 10 reviewed studies. The results suggested that changes in HPA axis regulation are present in many adults who experienced CSA-with and without a current MDD or PTSD diagnosis. Further research is needed to verify these findings. The review results can help researchers determine research strategies that will optimize scarce subject and financial resources.
Asunto(s)
Abuso Sexual Infantil , Sistema Hipotálamo-Hipofisario , Salud Mental , Sistema Hipófiso-Suprarrenal , Niño , Humanos , Modelos TeóricosRESUMEN
The role of culture in evidence-based practice (EBP) is examined using the components of the EBP process as a framework for discussion. Issues that are identified include the recruitment and retention of ethnic groups in research; paternalism and institutional racism in regard to those who cannot afford best practice; and cultural differences between health professionals and patients in their understanding of best practice, health, and illness. Strategies that are suggested to reduce cultural incongruence include shared clinical decision making and development of a cultural knowledge system to improve EBP and outcomes on an organizational level.
Asunto(s)
Competencia Cultural/psicología , Diversidad Cultural , Enfermería Basada en la Evidencia , Prejuicio , Proyectos de Investigación , Toma de Decisiones , Etnicidad , Conocimientos, Actitudes y Práctica en Salud , Humanos , Principios Morales , Satisfacción del Paciente , Selección de Paciente , Grupos RacialesRESUMEN
OBJECTIVE: To evaluate and compare the psychometric qualities of three retrospective, multi-item measures of childhood sexual abuse (CSA): the CSA Frequency Scale, CSA Count Index, and CSA Multiple Characteristics Index. METHODS: Two samples of women 20-50 years old who experienced CSA were recruited from a family practice clinic (N=132) and the community (N=19). The measures were designed to represent the three most commonly used approaches for multi-item measurement of past CSA, as determined by a review of literature. Items were derived from a self-administered instrument from a larger study. The CSA Frequency Scale was evaluated for test-retest reliability, internal consistency, and criterion-related validity. The CSA Count and CSA Multiple Characteristics Indexes were evaluated for content specification, indicator specification, indicator collinearity, external validity, criterion-related validity, and test-retest reliability. Criterion-related validity variables were (a) physical and psychosocial symptomatology and (b) depression. RESULTS: Upon evaluation, all three measures met criteria for satisfactory quality, with one exception: external validity for both indexes. When compared across test-retest reliability and criterion-related validity results, none of the measures proved superior. Intraclass correlation coefficients for test-retest reliability ranged from .92 to .94; correlations with the criterion-related validity variables ranged from r=.36 to .41. CONCLUSIONS: The results support the continued use of established scales similar to the CSA Frequency scale. In addition, the results suggest further development and standardization of indexes similar to the CSA Count and Multiple Characteristics Indexes is warranted.
Asunto(s)
Abuso Sexual Infantil/diagnóstico , Recuerdo Mental , Encuestas y Cuestionarios , Adulto , Niño , Abuso Sexual Infantil/psicología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Medicina Familiar y Comunitaria , Femenino , Humanos , Persona de Mediana Edad , Psicometría/estadística & datos numéricos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Ajuste Social , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicologíaRESUMEN
Clear descriptors of faculty practice and scholarly activities are essential to precisely demonstrate that the faculty practice role meets the standards of academic advancement and to influence academic policy. A description of scholarly clinical activities (1) justifies the benefits of faculty practice by means other than fiscal, (2) provides data for research regarding faculty practice, and (3) provides data to support the nursing profession's political, social, and health care agendas. Guidelines for clinical scholarship are described in this article. A review of relevant literature demonstrates that these guidelines go beyond current models by describing 24 scholarly activities organized into 4 areas: quality, governance, leadership, and knowledge development. Three years of data describing the scholarly activities of a college of nursing faculty engaged in practice are presented to demonstrate the effectiveness of the indicators in achieving these goals. These data can provide valuable information for trend analysis and, through heightened awareness of opportunities, increase faculty clinical scholarship activities.
Asunto(s)
Guías como Asunto , Práctica del Docente de Enfermería/normas , Recolección de Datos/métodos , Humanos , Nebraska , Indicadores de Calidad de la Atención de Salud , Análisis y Desempeño de TareasRESUMEN
With the wide variety of health problems reported by adults who experienced childhood sexual abuse (CSA), and no universality for any of them, it is vital that treatment and research be theory-based. The purpose of this article is to review the highlights of major theories, models, and conceptual frameworks found in the literature that explain the relationship of CSA with adult health problems, along with their associated moderating or mediating variables. The theories vary in their scope (macro, middle range, or micro), and in the health problems they explain, from purely psychosocial to both physical and psychosocial problems.
Asunto(s)
Abuso Sexual Infantil , Enfermedad/etiología , Modelos Neurológicos , Teoría Psicológica , Adulto , Encefalopatías/etiología , Encefalopatías/psicología , Niño , Abuso Sexual Infantil/psicología , Enfermedad/psicología , Humanos , Neurobiología , Trastornos Somatomorfos/etiología , Trastornos Somatomorfos/psicología , Estrés Psicológico/fisiopatologíaRESUMEN
In this comprehensive review of retrospective childhood sexual abuse (CSA) instruments, instruments from studies published between 1986 and 2001 are examined according to administration method, number and specificity of questions, CSA operational definitions, psychometric properties, and the use of scales. It was found that both self-administered and interview instruments range from the vagueness of a single question to the preciseness of multiple, specific questions. Furthermore, the review demonstrated that CSA instruments generally lack standardization. Many are developed for one-time use and others modified when reused. Descriptive CSA instruments have been preferred by researchers and primarily used to measure CSA dichotomously. However, little consensus exists as to how to operationally define CSA. One positive trend is the development of scales that measure CSA as an interval-level variable, allowing for more extensive psychometric data to be collected.
Asunto(s)
Abuso Sexual Infantil/diagnóstico , Encuestas y Cuestionarios , Niño , Humanos , Psicometría/instrumentación , Estudios RetrospectivosRESUMEN
The purpose of this study was twofold: (a) to cluster women who experienced childhood sexual abuse (CSA) according to their shared patterns of CSA characteristics and (b) to examine differences across clusters on measures of other childhood abuse and adult health. Seven CSA characteristic variables were used for cluster analysis. The seven-cluster solution that emerged ranged from a noncontact extrafamilial CSA cluster that occurred without force only once to the most severe clusters in which penetration by an intrafamilial or extrafamilial abuser occurred multiple times with force. Significant differences among clusters were found for childhood emotional abuse and physical abuse, adult physical and psychosocial symptomatology, and depression. There were no significant differences for health care utilization. The results promote further understanding of which victims of CSA are more likely to have experienced other forms of childhood abuse and which victims are more at risk for poor health in adulthood.
Asunto(s)
Abuso Sexual Infantil/psicología , Víctimas de Crimen/psicología , Medicina Familiar y Comunitaria/estadística & datos numéricos , Estado de Salud , Salud de la Mujer , Adolescente , Adulto , Atención Ambulatoria/estadística & datos numéricos , Niño , Maltrato a los Niños/psicología , Maltrato a los Niños/estadística & datos numéricos , Abuso Sexual Infantil/estadística & datos numéricos , Análisis por Conglomerados , Depresión/etiología , Relaciones Familiares , Femenino , Humanos , Relaciones Interpersonales , Persona de Mediana Edad , Medio Oeste de Estados Unidos , Relaciones Padres-Hijo , Escalas de Valoración PsiquiátricaRESUMEN
The study purpose was to determine (a) health-promoting lifestyle behaviors of Spanish-speaking Hispanics, (b) differences in these behaviors by demographics and acculturation, and (c) the extent to which perceived health status, demographics, and acculturation explain health-promoting lifestyles. The Spanish-language Health-Promoting Lifestyle Profile II (HPLPII) and other instruments were completed by a convenience sample of 545 Hispanic adults recruited in several midwestern communities. Of the six behavioral dimension scores of the HPLPII, scores were lowest for physical activity and highest for spiritual growth. They differed by age, gender, employment status, marital status, and acculturation. Perceived health status, demographics, and acculturation explained 12% of the variance in overall health-promoting lifestyle. These findings can help guide culturally appropriate interventions designed to improve this population's overall health.