RESUMEN
BACKGROUND: Although asthma can be associated with significant airflow obstruction in those over the age of 65, it is often underdiagnosed and undertreated. OBJECTIVE: To describe severity of asthma, allergy skin test sensitivities, indoor allergen exposures, and the impact on quality of life (QOL) and health status in elderly persons with asthma. METHODS: A cross-sectional data analysis with 80 elderly persons with asthma recruited from medical, geriatric, and allergy/immunology tertiary care centers. Asthma severity was determined by symptoms and measurements of lung function. House dust specimens were collected from mattresses and bedroom carpets and analyzed separately for the major allergens of house dust, using monoclonal antibody-based immunoenzymetric assays. QOL was measured using Juniper's Asthma Quality of Life Questionnaire. Health status was measured using the Short Form Health Survey Medical Outcome Questionnaire which included Ferrans and Powers' Quality of Life Index subscales. RESULTS: Two-thirds of participants had either moderate or severe persistent asthma. Skin tests to a battery of common airborne allergens were positive to at least one allergen in 56 of the 75 participants tested (74.7%). Reservoir dust allergen levels were often high enough to place participants at risk of symptoms or at risk of developing sensitization. Increased asthma severity was associated with significantly lower QOL and a trend toward decreased health status. CONCLUSIONS: Asthma is a significant chronic problem in the elderly. Atopy was common. Asthma severity impacts on these participants' QOL and health status. Results support interventions aimed at identifying allergens precipitating attacks and reducing them in the home.
Asunto(s)
Asma/epidemiología , Hipersensibilidad Inmediata/epidemiología , Anciano , Contaminación del Aire Interior/efectos adversos , Contaminación del Aire Interior/análisis , Alérgenos/efectos adversos , Animales , Animales Domésticos , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Asma/etiología , Asma/psicología , Baltimore/epidemiología , Ropa de Cama y Ropa Blanca , Gatos , Cucarachas/inmunología , Perros , Utilización de Medicamentos/estadística & datos numéricos , Polvo , Exposición a Riesgos Ambientales , Indicadores de Salud , Vivienda , Humanos , Humedad , Hipersensibilidad Inmediata/etiología , Hipersensibilidad Inmediata/psicología , Proteínas de Insectos/efectos adversos , Proteínas de Insectos/inmunología , Calidad de Vida , Índice de Severidad de la Enfermedad , Pruebas Cutáneas , Fumar/epidemiología , Espirometría , Población UrbanaRESUMEN
The purpose of this study was to examine the socio-demographic and behavioral differences related to obesity between African-American men and women. Obesity was defined as a body mass index of greater than 27.3 kg/m2 for women and 27.8 kg/m2 for men. Data were collected from 661 African-Americans, 418 women and 243 men, residing in wards 7 and 8 in Washington, DC through telephone interviews. Obesity was prevalent among 38.3% of the women and 20.1% of the men (p < 0.01). For women age 55 or older, annual income over $20K, having less than a high school education, and alcohol and tobacco consumption were associated with being overweight in the initial bivariate analysis (p < 0.05). For men, being 35 years or older and unemployment were significant factors associated with obesity. Our final analysis, when known dietary risk factors were adjusted, revealed that in women, obesity was associated with age, hard liquor consumption and non use of tobacco. For men, older age was a primary association. We concluded that gender, with increasing age, plays a significant role in predicting obesity, as defined by concurrent national standards. African American men 55 years of age or older are the most likely group to be overweight even after predisposing and behavioral risk factors are considered.
Asunto(s)
Población Negra , Obesidad/etnología , Caracteres Sexuales , Adolescente , Adulto , Índice de Masa Corporal , Causalidad , Susceptibilidad a Enfermedades , District of Columbia/epidemiología , Conducta Alimentaria/etnología , Conducta Alimentaria/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/etiología , Prevalencia , Estudios Retrospectivos , Factores SocioeconómicosRESUMEN
OBJECTIVE: To assess the adequacy of the Primary Care Assessment Tool-Child Edition (PCAT-CE) for evaluating the attainment of the key characteristics of primary care services for children and youth. DESIGN: Community-based telephone survey. SETTING: Specific political subdivision in Washington, DC. PARTICIPANTS: Four hundred fifty parents/guardians of offspring 18 years of age or less. MEASURES: Reliability, validity and principal component analysis of 5 scales representing key aspects of the 4 cardinal domains of primary care included in the PCAT-CE. In addition, 2 subdomains (first contact use and extent of affiliation with a primary care source) were included as indices to describe overall patterns of use and affiliation with the particular source of care. RESULTS: Most scales had adequate internal consistency, test-retest reliability, and construct validity. The principal components factor analysis yielded 5 separate factors. These corresponded to the subdomains of first contact accessibility; coordination of care; characteristics of the professional-patient relationship over-time; and comprehensiveness (both services available and indicated services received). CONCLUSIONS: Psychometric assessment supported the integrity and general adequacy of the PCAT-CE for assessing the characteristics and quality of primary care for children and youth. Testing of revised versions in a variety of different settings is underway. A major component of this testing is to explore the possibility of reducing the number of items while retaining sufficient detail about each component of primary care to make judgements about people's experiences with that care.
Asunto(s)
Servicios de Salud del Niño , Satisfacción del Paciente , Atención Primaria de Salud , Niño , District of Columbia , Análisis Factorial , Humanos , Psicometría , Calidad de la Atención de Salud , Reproducibilidad de los ResultadosRESUMEN
PURPOSE/OBJECTIVES: To describe pain, psychological distress, health status, and coping that patients with breast cancer who were scheduled for autotransplantation experienced; the strength and direction of relationships among pain, psychological distress, health status, and coping; and the percentage of variance within the concept of health status that age, pain, psychological distress, and coping. DESIGN: Descriptive, correlational. SETTING: An urban, National Cancer Institute-designated comprehensive cancer center located in the eastern United States. SAMPLE: A convenience sample of 83 female patients with breast cancer scheduled for autotransplantation. The population age ranged from 22-59 years (X = 44.47 years) and was comprised of 72 (88%) Caucasians, 6 (7%) African Americans, and 4 (5%) from other minorities. METHODS: An oncology clinical nurse specialist in the outpatient medical oncology clinic collected the data during a regularly scheduled visit approximately 20 days prehospitalization for high-dose chemotherapy and autotransplantation. Data were collected using a demographic data from and self-report instruments (Gaston-Johansson Painometer, State-Trait Anxiety Inventory, Beck Depression Inventory, Medical Outcomes Study Short-Form General Health Survey, and Coping Strategies Questionnaire). MAIN RESEARCH VARIABLES: Pain, psychological distress, health status, and coping. FINDINGS: Although the subjects experienced low pain intensity, the range of reported pain intensity ratings was wide. Pain locations varied but were reported mainly in the vagina, chest, shoulder, and arm. Although subjects reported primarily mild depression and mild state anxiety, the range of depression and state anxiety scores was wide. Coping strategies used most frequently to deal with pain included positive coping statements, diverting attention, praying and hoping, increasing activity level, and ability to control and decrease pain. Subjects reported moderate total health status and low role functioning. Moderate, positive correlations were seen between state anxiety and depression and physical functioning and role functioning. Sixty-five percent of the variance in health status was explained by sensory pain depression, and catastrophizing. CONCLUSIONS: Patients with breast cancer who are scheduled for autotransplantation may experience pain, psychological distress, and alterations in coping and perceived health status. Total pain intensity, sensory pain, depression, and catastrophizing appear to be important variables related to the patient's perceived health status. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to include assessment of pain, psychological distress, health status, and coping in their routine patient assessment prior to autotransplantation to provide appropriate care and make necessary multidisciplinary referrals. Future nursing research should be directed toward the implementation and evaluation of interventions that promote the use of comprehensive coping strategies to decrease pain, anxiety, and depression.
Asunto(s)
Adaptación Psicológica , Trasplante de Médula Ósea/psicología , Neoplasias de la Mama/psicología , Neoplasias de la Mama/terapia , Dolor/psicología , Estrés Psicológico/psicología , Adulto , Neoplasias de la Mama/complicaciones , Femenino , Estado de Salud , Humanos , Modelos Lineales , Persona de Mediana Edad , Análisis Multivariante , Dolor/etiología , Estrés Psicológico/etiología , Estados UnidosRESUMEN
In October 1997, 790 school nurses in Maryland and the District of Columbia were surveyed to determine their attitudes, knowledge, and beliefs about asthma. Results for 550 (70%) nurses indicated school nurses possess a generally appropriate level of knowledge concerning asthma, and most asthma myths have been replaced with knowledge. However, school nurses also have varied responsibilities that affect their ability to provide health education and support services to children with asthma at school. Little time is available for a proactive role. Concerns about the criteria and follow-up for delegating medication administration within the school setting were reported. A lack of communication existed with parents about the child's asthma. Open communication between school nurses and the family is recommended to establish a partnership and improve asthma management outcomes. In addition, school policies and procedures should be updated to meet the demands of children with asthma.
Asunto(s)
Asma/prevención & control , Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Perfil Laboral , Evaluación de Necesidades/organización & administración , Personal de Enfermería/educación , Personal de Enfermería/psicología , Servicios de Enfermería Escolar/educación , Servicios de Enfermería Escolar/métodos , Adulto , Asma/tratamiento farmacológico , Competencia Clínica/normas , Comunicación , District of Columbia , Educación Continua en Enfermería , Femenino , Humanos , Masculino , Maryland , Persona de Mediana Edad , Relaciones Profesional-Familia , Encuestas y CuestionariosRESUMEN
The authors present evidence on the utility of standard health assessment information (i.e. health status, behavioural, and sociodemographic characteristics) collected by nurses for predicting the psychosocial and physiological healthcare needs of persons with HIV/AIDS in four clinical settings. A cross-sectional descriptive design using 386 patients tested the predictive accuracy of 10 predictors against 8 criterion variables. Multiple correlation and regression analyses produced employment status and income level as statistically significant predictors of several types of psychosocial needs. Only one equation with employment, medical diagnosis, and income predicting Health Behaviours/Social Support was clinically significant.
Asunto(s)
Empleo , Infecciones por VIH/terapia , Necesidades y Demandas de Servicios de Salud , Estado de Salud , Renta , Adulto , Anciano , Estudios Transversales , Femenino , Infecciones por VIH/enfermería , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Análisis de RegresiónRESUMEN
This study describes the psychosocial and physiological health care needs of persons with HIV/AIDS in hospital, outpatient, home care, and long-term care settings. A cross-sectional descriptive design with 386 patients selected from the four settings was used to test between-setting differences on Healthcare Needs Scales. Univariate analyses of variance of scale and subscale scores and Kruskal-Wallis analyses of variance by ranks on item scores were computed. There was neither a relationship between psychosocial and physiological health care needs nor a distinctive pattern of needs across settings by HIV classification. The patients' needs varied between settings on health behaviors/social support, health management, and elimination/physical/sensory functions but were quite similar in psychosocial/financial support and neurological/digestive functions. These results question assumptions about the relationships among stage of HIV infection, level and type of health care need, and type of setting and suggest that health system resources and nursing care focus on both the psychosocial and physiological needs of persons with HIV/AIDS using individualized protocols.
Asunto(s)
Infecciones por VIH/enfermería , Necesidades y Demandas de Servicios de Salud , Adolescente , Adulto , Anciano , Atención Ambulatoria , Análisis de Varianza , Estudios Transversales , Femenino , Infecciones por VIH/clasificación , Infecciones por VIH/psicología , Servicios de Atención de Salud a Domicilio , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Instituciones de Cuidados Especializados de Enfermería , Encuestas y CuestionariosRESUMEN
The authors report on the quantitative analysis phase in the development of the Healthcare Needs Scales for Patients with HIV/AIDS (Berk, Poe, & Bagis-Smith, 1992). The scales were administered to a cross-sectional sample of 386 patients from hospital, outpatient HIV clinic, homecare, and long-term care settings. The authors collected construct validity evidence based on a factor analysis and comprehensive item, subscale, and scale analyses, concurrent validity evidence of primary caretakers serving as proxies for hospital patients, and internal consistency reliability evidence. The results produced an instrument for diagnosing the psychosocial and physiological needs of the target population.