RESUMEN
BACKGROUND AND OBJECTIVES: Approximately 65% of psychiatric inpatients experience moderate-to-severe nicotine withdrawal (NW), a set of symptoms appearing within 24 hr after an abrupt cessation or reduction of use of tobacco-containing products in those using nicotine daily for at least a couple of weeks. The Minnesota Tobacco Withdrawal Scale (MTWS) is a widely used instrument for detecting NW. However, the psychometric properties of the MTWS have not previously been examined among patients with serious mental illness (SMI) undergoing tobacco-free hospitalization. The objective of this study was to examine the validity and reliability of the MTWS among patients with SMI during tobacco-free psychiatric hospitalization. METHODS: Reliability was tested by examining Cronbach's α and item analysis. Validity was examined through hypothesis testing and exploratory factor analysis (N = 255). RESULTS: The reliability analysis yielded a Cronbach's α coefficient of .763, an inter-item correlations coefficient of .393, and item-total correlations between .291 and .691. Hypothesis testing confirmed the construct validity of the MTWS, and an exploratory factor analysis yielded a unidimensional scale. CONCLUSION: The MTWS demonstrated adequate reliable and valid psychometric properties for measuring NW among patients with SMI. Nurses and other health-care professionals may use this instrument in clinical practice to identify patients with SMI experiencing NW. The MTWS is psychometrically sound for capturing NW during tobacco-free psychiatric hospitalization. Future research should examine the efficacy of the MTWS in measuring NW in this population over an extended period of hospitalization.
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Trastornos Mentales/psicología , Psicometría/estadística & datos numéricos , Cese del Hábito de Fumar/psicología , Cese del Hábito de Fumar/estadística & datos numéricos , Síndrome de Abstinencia a Sustancias/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Minnesota , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
Using data from a longitudinal study of breastfeeding in Hispanics, this study evaluated the influence of early skin-to-skin contact (SSC) on initiation and sustained exclusive breastfeeding (EBF) at 1 month postpartum. Two-thirds of the women in the sample participated in early SSC. At discharge, over half of the women were EBF; this proportion decreased to one-third at 1 month postpartum. Controlling for demographic and clinical variables in the model, participation in early SSC was associated with a greater than sevenfold increase in the odds of EBF at discharge (p = .005) but was not predictive of EBF at 1 month post-discharge (p = .7). Younger maternal age and increased prenatal infant feeding intention were associated with an increased likelihood of EBF across both timepoints. Promoting early SSC may help with initiation of EBF, while further breastfeeding support may be needed to maintain EBF following discharge for this vulnerable population.
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Lactancia Materna/etnología , Emigrantes e Inmigrantes/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Método Madre-Canguro/estadística & datos numéricos , Adulto , Emigrantes e Inmigrantes/psicología , Femenino , Hispánicos o Latinos/psicología , Humanos , Intención , Método Madre-Canguro/psicología , Kentucky/epidemiología , Estudios Longitudinales , Edad Materna , Factores SocioeconómicosRESUMEN
BACKGROUND: Although Hispanic mothers in the United States have slightly higher rates of breastfeeding initiation than the national average, they are more likely to supplement with formula. OBJECTIVES: To describe infant feeding decisions in a sample of 72 urban Hispanic mothers and assess whether demographic and personal factors influence exclusive breastfeeding (EBF) status at 4 months postpartum. METHODS: The study was longitudinal and included assessments during pregnancy, in the hospital following childbirth, and monthly up to 4 months following birth. RESULTS: Nearly all of the 72 mothers were breastfeeding at discharge after the birth of their infant (94%); half of these were EBF. By 2 months postpartum, the rate of EBF had declined to 26%, dropping to 22% by 4 months. Significant predictors of EBF status at 4 months included the baseline indicator for mother's partner as the most important person in life (adjusted odds ratio [AOR], 5.42; 95% confidence interval [CI], 1.03-28.66) and breastfeeding self-efficacy score at 1 month (AOR, 1.20; 95% CI, 1.07-1.34). CONCLUSION: These findings have particular relevance in this population, given the high rate of breastfeeding initiation coupled with breastfeeding self-efficacy being a modifiable factor. Support during pregnancy and postpartum, including consultation with a lactation consultant, may increase the self-efficacy of EBF in this low-income population, leading to higher rates of extended EBF among Hispanics.
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Lactancia Materna/estadística & datos numéricos , Conducta Materna , Esposos , Adolescente , Adulto , Lactancia Materna/etnología , Demografía , Femenino , Hispánicos o Latinos , Humanos , Recién Nacido , Kentucky/epidemiología , Estudios Longitudinales , Masculino , Periodo Posparto , Embarazo , Población Urbana , Adulto JovenRESUMEN
OBJECTIVES: The purpose of this study was to determine if pain level was associated with demographic or surgery-specific characteristics among patients recovering from ambulatory surgery; and to assess the relationship between pain level and nausea over the 7-day postoperative period, controlling for demographic and surgery-related covariates. MATERIALS AND METHODS: This longitudinal study assessed the pain and nausea of 248 eligible patients during the day of surgery (DOS) and the 7 days following ambulatory surgery. Postoperative data were assessed using standardized questions about severity of pain and nausea symptoms. Participants who had a cumulative pain score of ≥24 over the 8-day period were categorized as having high pain. Repeated-measures analysis of variance was used to assess differences in nausea by pain group over time, controlling for demographic, surgical variables, and antiemetic and analgesic use. RESULTS: There were significant differences between 2 pain groups in age, surgical procedure, cumulative morphine equivalent dose, and use of antiemetics postdischarge. The longitudinal analysis demonstrated that patients in the high-pain group reported a greater degree of nausea on DOS and on each of the first 5 days postsurgery, controlling for differences in age, sex, education, use of antiemetics presurgery and postsurgery, use of acetaminophen postsurgery, daily morphine equivalent dose, and surgical procedure. DISCUSSION: Younger patients and those receiving orthopedic procedures may be at greatest risk for postoperative pain. Patients with high pain reported a significantly greater degree of nausea on DOS through the first 5 days postdischarge. As the majority of surgeries are now conducted in the ambulatory setting, it is imperative that we determine pain management regimens and patient education practices that will allow for a more comfortable recovery for our patients.
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Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Dolor Postoperatorio/etiología , Náusea y Vómito Posoperatorios/etiología , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/uso terapéutico , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Morfina/uso terapéutico , Dimensión del Dolor , Adulto JovenRESUMEN
Exclusive breastfeeding (EBF) is the most efficacious form of infant feeding and nutrition. Hispanic mothers in the US are more likely than mothers of other racial/ethnic groups to supplement with formula in the first 2 days of life. The purpose of this study was to explore infant feeding intentions during the prenatal period as a predictor of EBF at postpartum discharge in a sample of Hispanic women (n = 99). At discharge, 51 % of the women were EBF, 44 % were breastfeeding and supplementing with formula, and 5 % were feeding only formula. Intention to breastfeed was found to be a strong and potentially modifiable predictor of breastfeeding behavior, showing a significant association with EBF upon discharge from the hospital after birth when linked with acceptance of pregnancy and method of delivery. Prenatal care offers a unique opportunity to enhance intentions to breastfeed that may lead to improved EBF in this health vulnerable population.
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Lactancia Materna/etnología , Hispánicos o Latinos/estadística & datos numéricos , Aculturación , Adolescente , Adulto , Lactancia Materna/psicología , Lactancia Materna/estadística & datos numéricos , Femenino , Hispánicos o Latinos/psicología , Humanos , Intención , Kentucky , Estudios Longitudinales , Embarazo , Adulto JovenRESUMEN
BACKGROUND: One-third of patients with heart failure (HF) experience depressive symptoms that adversely affect health-related quality of life (HRQOL). We aimed to describe depressive symptom trajectory and determine whether a change in depressive symptoms predicts subsequent HRQOL. METHODS AND RESULTS: The sample consisted of 256 inpatients and outpatients with HF. Depressive symptoms were measured at baseline and 3 or 6 months with the Patient Health Questionnaire (PHQ-9). The Minnesota Living with HF Questionnaire was used to assess HRQOL at baseline, 3 to 6 months, and 1 year. Based on baseline and 3- to 6-month PHQ-9 scores, patients were categorized as depressive symptom-free (64%), depressive symptoms improved (15%), depressive symptoms developed (6%), or persistent depressive symptoms (15%). The groups differed in 1-year HRQOL levels (F = 36, P < .001); patients who were depressive symptom-free or whose depressive symptoms improved had better 1-year HRQOL than patients with persistent depressive symptoms (Tukey honestly significant difference, P < .01). Change in depressive symptoms was the strongest predictor of 1-year HRQOL (standardized ß = .42, P < .001), after controlling for functional status, demographics, and clinical variables. CONCLUSIONS: We found the trajectory of depressive symptoms predicts future HRQOL. Research is needed to determine whether interventions targeting depressive symptoms improve HRQOL in patients with HF.
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Depresión/psicología , Estado de Salud , Insuficiencia Cardíaca/psicología , Calidad de Vida/psicología , Anciano , Depresión/diagnóstico , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Encuestas y CuestionariosRESUMEN
AIMS: To evaluate cultural differences in sociodemographic factors, illness severity and parents' perception of their adolescent's quality of life for Icelandic and USA families of adolescents with asthma; and to determine predictors of parent-rated quality of life. BACKGROUND: Asthma is known to have an impact on the quality of life of affected adolescents and their families, but few studies have addressed parents' perception of their adolescent's health-related quality of life. DESIGN: Cross-sectional exploratory study. METHOD: The study involved families of adolescents with asthma included 15 from Iceland and 15 from USA, recruited from paediatric practices. Parent and adolescent participants completed questionnaires; this study is based on the parent responses. Data were collected from January-May 2006. FINDINGS: While parents from Iceland and USA were similar in demographic characteristics, parents from Iceland rated their children's health-related quality of life (PedsQL(TM) 3.0, Varni 1998) more positively than did USA parents, even though Icelandic parents were more likely than their USA counterparts to report that their adolescent's asthma is severe. Significant predictors of parent-rated quality of life included location (higher scores for Icelandic parents), gender (higher scores for parents of boys), exposure to second hand smoke in the home (higher scores for those not exposed) and frequency of troublesome wheezing (higher scores for lower frequency). CONCLUSION: Quality of life has been acknowledged as an essential health outcome measure. Even though gender difference was not found in asthma severity, parents of boys perceived their adolescent's quality of life as more positive compared with parents of girls. It might be helpful for Icelandic and USA families to integrate into care delivery models, cultural differences in parent-rated quality of life. RELEVANCE TO CLINICAL PRACTICE: Asthma management interventions may improve quality of life for adolescents with asthma by reducing symptoms. Interventions promoting smoke-free homes and enhanced self-monitoring to prevent exacerbations may improve quality of life.
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Asma/fisiopatología , Padres/psicología , Calidad de Vida , Adulto , Femenino , Humanos , Islandia , Masculino , Estados UnidosRESUMEN
OBJECTIVES: The objective of this pilot study is to assess the need, desire, and applicability of a mammography promotion project in the emergency department (ED). DESIGN AND SAMPLE: A convenience sample from the ED of a public University hospital was surveyed to determine their mammography status, interest in a program to promote mammography, and barriers to mammography. MEASURES: The survey included demographics information, health care access, including health insurance and primary care provider, mammography status and date of mammogram, as well as a checklist of potential barriers. Participants were also asked whether they would be interested in mammography promotion in this setting. RESULTS: More than 15% of the 197 women surveyed had never received a mammogram, and more than half had not received 1 in the past year. The most common barriers to mammography were competing demands and money. Three quarters of the women said they would be interested in mammography promotion while waiting for care in the ED. CONCLUSIONS: This study provides promise that mammography promotion activities may be appropriately placed in the ED and provides a solid platform from which researchers and nurses may launch efforts to develop preventive health interventions in innovative public health care settings.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/métodos , Mamografía/estadística & datos numéricos , Mercadeo Social , Adulto , Femenino , Encuestas de Atención de la Salud , Humanos , Modelos Psicológicos , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Estudios ProspectivosRESUMEN
BACKGROUND: Physical symptoms are likely to occur in clusters that may be associated with adverse outcome in patients with heart failure (HF). Despite the importance of early recognition of worsening symptoms in HF management, the impact of physical symptoms on adverse outcome has not been explored in the context of symptom clusters. PURPOSE: The purposes of this study were to explore which physical symptom clusters occur in HF patients and to determine the impact of symptom clusters on event-free survival. METHODS: A total of 421 patients (60% male; 62 [SD, 14] years; 72% New York Heart Association class II/III) completed the modified Memorial Symptom Assessment Scale-Heart Failure to measure physical symptoms during an index hospitalization in Seoul, Korea. Times to first event of cardiac rehospitalization and cardiac death were collected for 12 months after discharge and confirmed by review of hospital records. An agglomerative hierarchical clustering approach with Ward's method was used to identify symptom clusters. Hierarchical Cox hazard regression was used to determine the impact of symptom clusters on cardiac rehospitalization and cardiac mortality. RESULTS: Two distinct symptom clusters, the dyspneic and the weary symptom clusters, occurred in patients with HF. Shortness of breath, difficulty breathing when lying flat, and waking up breathless at night comprised the dyspneic symptom cluster. Lack of energy, lack of appetite, and difficulty sleeping comprised the weary symptom cluster. In hierarchical Cox hazard regression, elevated distress from the weary symptom cluster independently predicted cardiac rehospitalization (hazard ratio, 1.45; 95% confidence interval, 1.09-1.93), and increased distress from the dyspneic symptom cluster independently predicted cardiac mortality (hazard ratio, 2.00; 95% confidence interval, 1.16-3.34). CONCLUSION: The weary and the dyspneic symptom clusters predicted cardiac rehospitalization and cardiac mortality, respectively. Patient education for self-monitoring of symptoms should focus on symptom clusters rather than single symptom.
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Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/mortalidad , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Causas de Muerte , Análisis por Conglomerados , Supervivencia sin Enfermedad , Disnea/epidemiología , Disnea/etiología , Fatiga/epidemiología , Fatiga/etiología , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/prevención & control , Insuficiencia Cardíaca/psicología , Humanos , Corea (Geográfico)/epidemiología , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Readmisión del Paciente/estadística & datos numéricos , Valor Predictivo de las Pruebas , Prevalencia , Modelos de Riesgos Proporcionales , Medición de Riesgo , Factores de Riesgo , Autocuidado , Estrés Psicológico/epidemiología , Estrés Psicológico/etiologíaRESUMEN
INTRODUCTION: Pregnant women often underreport their smoking status and extent of secondhand smoke (SHS) exposure. Biomarker confirmation is the recommended method to assess smoking behaviors and SHS exposure in both mothers and infants. OBJECTIVES: The primary aims are to (a) examine the relationship between smoking behaviors and SHS exposure in mother-baby couplets using maternal and infant hair nicotine and maternal urine cotinine analyses and (b) determine whether there is an association between maternal and infant hair nicotine samples obtained shortly after birth. DISCUSSION: A cross-sectional study with a multiethnic sample of 210 mother-baby couplets assessing SHS exposure. RESULTS: The level of maternal hair nicotine (MHN) was significantly different among three groups: nonsmoking, nonsmoking/passive exposed, and smoking (p < .0001), with nonsmoking and nonexposed women having the lowest level. Urine cotinine was strongly associated with self-reported smoking status (rho = .88; p < .0001). Maternal and infant hair nicotine were correlated, although MHN correlated more strongly with smoking status (rho = .46, p < .0001) than infant hair nicotine (rho = .39, p < .0001). CONCLUSIONS: MHN was a more precise biomarker of prenatal SHS exposure than infant hair nicotine; mothers' urine cotinine was strongly correlated with self-reported smoking status.
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Monitoreo del Ambiente/métodos , Exposición por Inhalación/análisis , Exposición Materna , Efectos Tardíos de la Exposición Prenatal/orina , Contaminación por Humo de Tabaco/análisis , Adulto , Biomarcadores/análisis , Biomarcadores/orina , Cotinina/análisis , Cotinina/orina , Estudios Transversales , Femenino , Cabello/química , Humanos , Lactante , Recién Nacido , Exposición por Inhalación/prevención & control , Exposición Materna/efectos adversos , Intercambio Materno-Fetal , Embarazo , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Efectos Tardíos de la Exposición Prenatal/diagnóstico , Contaminación por Humo de Tabaco/prevención & control , Adulto JovenRESUMEN
BACKGROUND: Increased anxiety correlates with increased complications after acute myocardial infarction. Anxiety levels and use of anxiolytic agents have not been compared between smokers and nonsmokers hospitalized because of acute myocardial infarction. OBJECTIVES: To compare anxiety level, sociodemographic factors, and clinical variables between smokers and nonsmokers hospitalized with acute myocardial infarction and to examine predictors of use of beta-blockers and anxiolytic agents among smokers and nonsmokers. METHODS: Secondary data analysis of a prospective multisite study on anxiety in 181 smokers and 351 nonsmokers with acute myocardial infarction. Anxiety was measured by using the State Trait Anxiety Inventory and the anxiety subscale of the Basic Symptom Inventory within 72 hours of admission. RESULTS: Smokers reported higher anxiety levels than nonsmokers reported on both anxiety scales. Female smokers reported the highest anxiety and peak pain levels of all, yet women were the least likely to receive anxiolytic agents. Smoking status was not a predictor for anxiety level when sex, peak pain, use of beta-blockers in the hospital, and age were controlled for. However, smokers were twice as likely as nonsmokers to receive an anxiolytic agent and 60% more likely to receive a beta-blocker in the emergency department, and smokers were 80% more likely than nonsmokers to receive an anxiolytic agent during hospitalization when these variables were controlled. CONCLUSIONS: Older female smokers are at risk for complications because they are older than their male counterparts and less likely to receive beta-blockers and antianxiety medications in the emergency department.
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Ansiolíticos , Ansiedad/tratamiento farmacológico , Ansiedad/etiología , Infarto del Miocardio/psicología , Fumar/psicología , Antagonistas Adrenérgicos beta , Ansiolíticos/uso terapéutico , Ansiedad/epidemiología , Australia/epidemiología , Estudios Transversales , Utilización de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/tratamiento farmacológico , Análisis de Regresión , Fumar/epidemiología , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
The objective of this study is to determine whether (1) Kuwaiti adolescents differ from Caucasian adolescents with respect to their cephalometric values; (2) sex plays a role in the differences between the two groups; and (3) a need exists to develop cephalometric standards for the Kuwaiti population. Standardized cephalometric films were obtained from 36 Kuwaiti females and 32 Kuwaiti males between the ages 11 and 14 years. Only subjects with Class I molar occlusion and a positive overjet of no more than 4 mm were selected. Each subject was age matched with White cephalometric values. Intraexaminer error, paired, and two-sample t-tests were made. The results show that there were significant differences between the Kuwaiti population and the Caucasian population for the majority of the variables tested (P < .01). Sex produced no significant effect on any of the variables studied. The Kuwaiti population has fuller lips, more facial convexity, greater dental protrusion, a more retruded and smaller mandible, and shorter posterior face height than the Caucasian population.
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Árabes , Cefalometría , Cara/anatomía & histología , Población Blanca , Adolescente , Estudios de Casos y Controles , Cefalometría/normas , Niño , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Kuwait , Labio/anatomía & histología , Masculino , Mandíbula/anatomía & histología , Maxilar/anatomía & histología , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Factores Sexuales , Diente/anatomía & histología , Dimensión VerticalAsunto(s)
Analgésicos Opioides/farmacocinética , Butorfanol/farmacocinética , Sistemas de Liberación de Medicamentos , Administración Intranasal , Adulto , Aerosoles , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/sangre , Área Bajo la Curva , Butorfanol/administración & dosificación , Butorfanol/sangre , Sistemas de Liberación de Medicamentos/instrumentación , Femenino , Semivida , Humanos , Masculino , Tasa de Depuración Metabólica , Equivalencia TerapéuticaRESUMEN
The purpose of this study was to examine smoking behavior and the desire to quit among low-income women. Two hundred and eight women caregivers were surveyed about their smoking status, exposure to environmental tobacco smoke in the home, and desire to quit smoking. Most of the smokers (74%) wanted to quit smoking. With a logistic regression model, the number of years smoked was the only significant predictor variable for the dependent variable of thoughts about quitting when age, years of smoking, number of children, marital status, number of smokers in the home, cigarettes smoked per day, and money spent per week on cigarettes were entered as independent variables. The fewer years smoked the more likely the women wanted to quit.
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Cuidadores/economía , Cuidadores/psicología , Cese del Hábito de Fumar/psicología , Fumar/psicología , Adolescente , Adulto , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Kentucky , Embarazo , Fumar/economía , Cese del Hábito de Fumar/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Factores de Tiempo , Contaminación por Humo de TabacoRESUMEN
AIMS: The purpose of this research was to characterize CYP2D6, GST-M1 and GST-T1 enzyme expression in human parathyroid tissue, and to determine whether or not there is any association between deficiencies in these enzymes and serum parathyroid hormone concentrations in patients with end-stage renal disease. METHODS: Surgical human parathyroid tissue was obtained and evaluated by immunohistochemistry for cellular localization of CYP2D6, GST-M1 and GST-T1 and colocalization of CYP2D6 with parathyroid hormone. Blood samples were collected from 328 Caucasian patients with end-stage renal disease for genetic testing of CYP2D6*3, *4, *5, *6, *7 and GST-M1*0 and GST-T1*0 alleles. Clinical chemistry data and serum intact parathyroid hormone (iPTH) concentrations were obtained from patient medical records. In 277 of the patients, the same laboratory performed all clinical tests. RESULTS: CYP2D6, GST-M1 and GST-T1 were present in human parathyroid tissue. CYP2D6 was colocalized with parathyroid hormone in parathyroid chief cells. Within the end-stage renal disease population, a nonfunctional CYP2D6 genotype was present in 18.2%[95% confidence interval (CI) 8.0, 28.4] of patients in the 1st iPTH concentration quintile (iPTH < 64 pg x mL(-1)), in 0% (95% CI 0, 7.5) of those in the 2nd quintile, in 1.8% (95% CI 0, 9.3) of those in the 3rd quintile, in 9.1% (95% CI 1.5, 16.7) of those in the 4th quintile, and in 16.7% (95% CI 6.8, 26.5) of those in the 5th quintile (iPTH > 347 pg x mL(-1)) (P = 0.001). Out of 12 CYP2D6-deficient females, seven were in the 1st iPTH concentration quintile and the remaining five were in the 5th quintile. Patients deficient in the GST-M1 and GST-T1 enzymes displayed a far more uniform frequency distribution relative to serum iPTH concentrations. CONCLUSIONS: The presence of CYP2D6, GST-M1 and GST-T1 in parathyroid cells was observed. An association is reported between a lack of CYP2D6 and iPTH concentrations in newly diagnosed end-stage renal disease patients. Gender and concomitant deficiency in GST-M1 and/or GST-T1 appear to define this association further. It remains to be established whether these associations reflect a cause-effect relationship between deficient expression of metabolizing enzymes and severity of secondary manifestation of renal failure.