ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:All infants exposed to human immunodeficiency virus (HIV) prenatally, even those who do not become infected, are at risk for developmental problems because of poverty, prenatal substance abuse, and maternal illness.Objectives:The purpose was to describe the development of infants of mothers with HIV and to determine, using hierarchical linear models, the longitudinal effects of child characteristics, parental caregiver characteristics, family characteristics, and parenting quality on development.Methods:Eighty-one infants born to women with HIV and their primary parental caregivers were followed-up until 18 to 24 months of age; 53 infants were always cared for by their biologic mothers, 16 were always cared for by kin or foster parents, and 12 had primary caregiver changes. Predictor variables and developmental outcomes were obtained at enrollment and 6, 12, 18, and 24 months.Results:Mental development and adaptive behavior scores decreased over age. Infants with changes in their primary caregiver had lower motor and adaptive behavior scores than infants remaining with consistent caregivers. Higher mental, motor, and adaptive behavior scores were associated with more positive attention and more negative control, whereas better language abilities were associated only with more positive attention. Child, maternal, and family characteristics had lesser effects. HIV-infected infants and infants of mothers with more education had lower mental, motor, and adaptive behavior scores. Male gender and more family conflict were associated with lower motor and adaptive behavior scores. Infants from smaller families had lower mental scores.Conclusions:Because both parenting quality and consistency of the primary caregiver influenced developmental outcomes, interventions with the mothers of these infants need to focus both on improving the quality of parenting and reducing the frequency of primary caregiver changes.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Irritable Bowel Syndrome (IBS) is a common chronic functional bowel disorder characterized by alterations in bowel patterns and abdominal pain. One factor that is conjectured to contribute to the onset of IBS is sexual and/or physical abuse in childhood or as an adult. This conjecture is supported by the increased prevalence of abuse experiences in persons with IBS when compared to healthy controls or those with organically-defined gastrointestinal (GI) disorders.Objectives:The purposes of the present study were to (a) compare the history of sexual and physical abuse in a sample of women with IBS to a sample of women without IBS and (b) to compare women with IBS who had sexual and physical abusive experiences to those who had not on GI symptoms, psychological distress, healthcare-seeking behavior, and physiological measures.Methods:Data were collected from two samples of women (ages 18-40 years) with IBS and controls were recruited through community advertisements and letters from a health maintenance organization. Participants completed questionnaires (i.e., Sexual and Physical Abuse, Bowel Disease Questionnaire, Symptom Checklist-90-R) during an in-person interview and completed a symptom diary each night across one menstrual cycle. Cortisol and catecholamine levels were determined in morning urine samples on 6 days across the menstrual cycle.Results:More women in the IBS group reported unwanted sexual contact during childhood relative to control women. Within the IBS group, minimal differences were found between those who had experienced abuse and those who had not. Women with IBS who had experienced abuse reported greater impact of GI symptoms on activity.Conclusions:The prevalence of a history of childhood sexual abuse experiences is elevated among women with IBS. However, within women with IBS, those with a history of abuse do not appear to be different from those with no history of abuse on GI symptoms, psychological symptoms, or physiological arousal indicators.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objectives:The purpose of this study was to compare the partial pressure of transcutaneous tissue oxygen (TcPO2) in persons with venous ulcers in four positions with and without inspired oxygen.Methods:TcPO2was evaluated two times, 4 weeks apart at a chest reference and three lower extremity sites.Results:Lower extremity resting TcPO2levels were lower in patients with venous ulcers than in healthy adults. Minimal changes in TcPO2occurred with position changes when subjects breathed room air. When arterial oxygen saturation was increased using inspired oxygen, TcPO2, used as an indicator of perfusion, was lower during leg elevation, sitting, and standing compared to lying supine (p< 0.05).Conclusions:Control of peripheral circulation and tissue oxygenation may be impaired in persons with venous ulcers. Leg elevation, sitting, and standing decreased wound perfusion and may not be beneficial to individuals with venous insufficiency and ulceration. Research is needed to explore relationships among tissue oxygenation, blood perfusion, compression, positioning, and venous ulcer healing.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Although research has documented the efficacy of maximal voluntary contraction (MVC) exercise for improved pelvic floor muscle (PFM) strength, the efficacy of submaximal voluntary contraction (SVC) exercise for treatment of genuine stress urinary incontinence (GSUI) has not been described.Objective:To compare the training-induced changes in endurance, strength, and muscle activity recruitment, and continence control in groups of women with GSUI who exercised the PFM using either near-maximal voluntary contraction (NMVC) or SVC effort.Methods:Training-induced changes in PFM response to exercise were tested by using a quasi-experimental design. Thirty-two women, randomly assigned to either the SVC or NMVC exercise protocol group, were tested before and after training on endurance, muscle contraction strength, muscle activity recruitment, 10-hour weighed pad test for grams of urine loss, and subject-rated severity and frequency of leakage episodes. Repeated measures of specific study variables were retrieved and analyzed from home-training device computer memory and diary records. Changes in muscle activity recruitment, measured as microvolts of electromyogram (EMG) amplitude, were correlated with changes in muscle contraction strength and endurance.Results:Increases in muscle contraction strength (t= 1.75;p= 0.045) and decreases in grams of urine leakage (t= −1.86;p= 0.036) were significant for the SVC group. No significant differences were found between the groups for changes in endurance, muscle activity recruitment, frequency of leakage episodes, or subject-rated severity of urine loss based on a 7-point Likert scale.Conclusions:Study findings suggest that SVC exercise designed with specificity for gain in neuromuscular control may be beneficial for strengthening the PFM and increasing endurance of contractions to attain and maintain continence in women with GSUI.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Fatigue is the most common and disturbing complaint reported by women during adjuvant breast cancer chemotherapy, but little is known about the mechanisms influencing it.Objectives:To test an explanatory model of variables influencing fatigue in women during the first three cycles of adjuvant breast cancer chemotherapy and to determine the extent to which model variables explain fatigue at treatments and predict fatigue at cycle midpoints.Methods:A prospective, correlational design with repeated measures was used. The sample included 60 women who received chemotherapy after surgery for Stage I or II breast cancer. Fatigue was measured by the Piper Fatigue Scale. Predictor variables and measures were health and functional status (MOS SF-36), chemotherapy protocol, health-promoting lifestyle behaviors (HPLPII), nutritional status (hematocrit [Hct] and body mass index [BMI]), symptom distress (MSDS), and initial reaction to the diagnosis of cancer (RDCQ). Multiple regression was used for path analyses.Results:Trimmed models of influences on fatigue were identified. At treatments, direct influences on fatigue were symptom distress (β = 0.45-0.76,p= 0.002-0.001), chemotherapy protocol (β = 0.26,p= 0.02), and interpersonal relations (IPR) behaviors (β = −0.28,p= 0.02); indirect influences were confronting reaction to the diagnosis through IPR behaviors and through symptom distress. At cycle midpoints, direct influences on fatigue were symptom distress from the previous treatment (β = 0.36-0.43,p= 0.004-0.001), physical and social function (β = −0.31-0.50,p= 0.02-0.001), and IPR behaviors (β = −22,p= 0.05); an indirect influence was confronting reaction to the diagnosis (through IPR behaviors). Variance explained in fatigue ranged from 42% to 62% at treatments and from 40% to 56% at cycle midpoints.Conclusions:Further testing of the model is warranted. Findings suggest that interventions to reduce symptom distress and promote health and functional status need to be developed and evaluated for effectiveness in modifying fatigue during adjuvant breast cancer chemotherapy.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Stroke is a major cause of disability in the United States. Over half a million Americans suffer strokes each year, and many of the 75% who survive are cared for in home settings, by family caregivers. The caregiving experience is often stressful and can result in negative physical and mental health outcomes for the family caregiver.Objectives:The purpose of this longitudinal study was to examine relationships between patient characteristics, characteristics of the caregiver, and caregiver coping resources with caregiver physical and mental health outcomes at 3 and 6 months after the loved one's stroke. A secondary aim was to compare family members' assessments of patient disability with ratings by clinicians.Methods:The caregiver study was conducted in collaboration with a study of patient outcome after stroke. Both studies used the same cohort of stroke patients and their primary caregivers. Detailed clinical assessment of patient status was conducted 1, 3, and 6 months after stroke. Caregivers (N= 83) completed mailed questionnaires 1, 3, and 6 months after the patient's stroke. The survey included quantification of fatigue and energy, assessment of mood disturbance, stress, spirituality, and reactions to the caregiving situation, which provided a detailed assessment of caregiver characteristics, coping resources, and physical and mental health status.Results:Caregivers reported stable perceptions of fatigue, vigor, recurrent sorrow, perceived stress, finances, family support, physical health, and depressive state symptoms at 1, 3, and 6 months after the loved one's stroke. The relationship between physical health and depressive symptoms was reciprocal at 3 and 6 months. Perceived stress was related to mental health at 3 and 6 months. Caregiver ratings of disability at 1 month paralleled clinical assessments using the Orpington Prognostic scale.Conclusions:Part of a comprehensive approach to stroke aftercare should include comprehensive assessment of caregiver functioning soon after the loved one's stroke. Early assessment might identify persons at greater risk for physical and mental health problems in a continuing caregiving role.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Although evidence indicates that women who suffer a myocardial infarction (MI) are less likely than men to be diagnosed based on their presenting symptoms, to receive aggressive treatment, and to survive an acute cardiac event, most studies conducted to date are retrospective chart reviews that examine the triage decision-making practices of physicians.Objectives:This study examined whether emergency department (ED) nurses' triage decisions were different when the nurse was presented with similar cues for MI, but different patient gender.Method:A nonexperimental, descriptive study was conducted. Five hundred ED nurses were randomly selected to receive a mailed clinical vignette questionnaire. Data analysis included descriptive, bivariate, and multivariate analyses.Results:ED nurses perceived the middle-aged male vignette patient to be in need of more urgent triage (t= 2.58;df= 207;p= 0.01) and an admission to an intensive care unit bed (χ2= 10.43;df= 1;p= 0.001) and were more likely to consider a cardiac diagnosis in the male than the age-matched female (χ2= 37.49;df= 1;p< 0.0001) with identical presentation. However, no such differences were noted in the elderly vignette patients.Conclusions:The findings of this study suggest that gender bias and ageism may account for the disparities in triage decisions for middle-aged women with complaints suggestive of coronary artery disease. Although middle-aged women may have a lower incidence of MIs than middle-aged men, their increased morbidity and mortality warrants its consideration.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID