ISSN:0029-6562    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:Inaccuracies in symptom perception may contribute to morbidity and mortality in childhood asthma.Objective:To systematically examine the accuracy of symptom perception on the part of children with asthma and their parents, as well as their interpretation and evaluation of the symptoms.Method:Twenty-eight patient/parent pairs from suburban and underserved urban pediatric populations participated in a 5-week protocol tracking subjective assessments of asthma severity (visual analog scales) and peak expiratory flow rates. Relationships between perceptual accuracy and demographic and disease factors were investigated.Results:Adolescents were more accurate than school-aged children, more accurate children had better morbidity outcomes, and African American parents were more accurate than Caucasian parents. Socioeconomic status did not affect accuracy. Both children and parents missed early symptoms and waited too long prior to intervening in an exacerbation.Conclusions:There are multiple opportunities for error in symptom perception and evaluation. Identification of the source of error is critical to the effective utilization of education on self-management.

ISSN:0029-6562    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:Symptom-limited exercise tests are widely used to evaluate the effects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), but the reliability of these tests is not well established in COPD patients.Objectives:We compared test-retest reliability of two repeated symptom-limited exercise tests between COPD patients and healthy elderly subjects and between male and female patients.Method:Fifty-six COPD patients (40 men, 16 women) and 16 healthy subjects (6 men, 10 women) performed two symptom-limited exercise tests approximately 2 weeks apart. Measures of oxygen uptake (V˙O2), minute ventilation (V˙E), heart rate, and ratings of breathlessness and leg fatigue were obtained at peak exercise at each symptom-limited exercise test.Results:Repeated measures of peak exercise responses were stable for patients and healthy subjects and for male and female patients. Although mean percent error (absolute difference ÷ mean) for peak exercise responses was low, some individuals' values exceeded 10%. There was no difference in the percent error between COPD patients and healthy subjects or between men and women with COPD. Test-retest reliability was lower for breathlessness ratings than for other peak exercise responses for all groups.Conclusions:Repeated symptom-limited exercise tests are reliable in COPD patients and healthy subjects. However, some individuals are less reliable, and these patients may require more than one exercise test to establish reliable performance.

ISSN:0029-6562    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:The Functional Performance Inventory (FPI) is a subjective measure of the performance dimension of functional status, based on an explicit analytical framework and the experiences of patients themselves.Objectives:To describe the conceptual foundation of the instrument, the procedures used to maximize content validity and the results of initial psychometric testing of the FPI in patients with chronic obstructive pulmonary disease (COPD).Method:Items and response structure for the instrument were drawn from the literature and qualitative interviews with 12 men and women with COPD. Twenty-four clinical and scientific experts participated in content validation. To assess the FPI's psychometric characteristics, 154 patients participated in a cross-sectional mail survey; 54 took part in a 2-week reproducibility assessment. Forty relatives were also included in validity testing.Results:The instrument was internally consistent (α = .96) and reproducible (ICC = .85). Validity was evident in the significant (p< .001) correlations found between the FPI total score and the Functional Status Questionnaire (activities of daily living,r= .68; instrumental activities of daily living,r= .68), Duke Activity Status Index (r= .61), Bronchitis-Emphysema Symptom Checklist (r= -.59), Basic Need Satisfaction Inventory (r= .61), and Cantril's Ladder of Life Satisfaction (r= .63). The relationship between patient FPI score and relative perception of functioning, using the Katz Adjustment Scale for Relatives, was also significant (socially expected activities,r= .53; free-time activities,r= .49,p< .01). The instrument discriminated between patients with severe and moderate levels of perceived severity and activity limitation (t= 8.52,p<.001) and patients with FEV1greater than and less than 1.0 liter (t= 4.25,p< .001).Conclusions:Results suggest that the FPI is a useful measure of functional performance in patients with COPD. Further development of the spiritual activities and work and school domains is in order, as is additional study of the instrument's responsiveness to change.

ISSN:0029-6562    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:With more single mothers entering the workforce due to welfare reform efforts, more hospitalized children from single-parent families will have experienced alternate child care arrangements where routine care is provided by adults other than the child's mother.Objectives:To investigate with secondary analysis of data whether experience with alternate child care has a moderating effect on the relationship between hospitalization and behavior of preschool children living in female-headed single-parent families.Method:A sample of 60 preterm and 61 full-term children who were 3, 4, or 5 years old was recruited for the larger longitudinal study. Behavior problems were measured with the Child Behavior Checklist. History of hospitalization and alternate child care arrangements were measured with the Life History Calendar.Results:Preschool children who experienced hospitalization without alternate child care experience had more somatic complaints, but those with both hospital and alternate child care experience had fewer aggressive behaviors than other children. For children with a history of hospitalization, aggressive behaviors decreased as the proportion of the child's life in alternate child care increased.Conclusions:Experience with alternate child care may ameliorate some of the negative effects of hospitalization, and potentially other novel and negative experiences, for preschool children. This could be due to child care providing positive experiences with separation from the mother, a peer group with which to talk about the novel experience, or actual instruction about the novel experience.

ISSN:0029-6562    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:Procedural pain management for very low birth weight (VLBW) neonates has been minimal or nonexistent in most neonatal intensive care units (NICUs).Objectives:To compare the efficacy of developmentally sensitive behavioral interventions (nonnutritive sucking via a pacifier, positioning) and sucrose for relieving procedural pain in VLBW infants and to determine the influence of contextual factors (gestational age, postnatal age, birth weight, severity of illness, frequency of painful procedures) on pain response.Method:In a prospective randomized crossover trial, pain was assessed in 122 VLBW neonates using the Premature Infant Pain Profile following four randomly ordered interventions during consecutive routine heel lance procedures.Results:Significant differences in pain existed among treatment interventions (F= 16.20,p< .0001). The pacifier with sucrose (F= 24.09,p< .0001) and pacifier with sterile water (F= 9.00,p= .003) significantly reduced pain. Prone positioning did not decrease pain (F=2.24,p=.137). Frequency of painful procedures approached significance in influencing pain response (F= 3.59,p= .01).Conclusions:The most efficacious interventions for reducing pain from single painful events were the pacifier with sucrose and the pacifier with sterile water. Research on the efficacy and safety of implementing these interventions, alone and in combination, for repeated painful procedures is needed. In addition, research is needed on the influence of implementing these interventions on pain response and clinical outcomes (e.g., health status and neurodevelopmental status) in VLBW neonates in the NICU.

ISSN:0029-6562    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:It is difficult to determine the usefulness of distraction to decrease children's distress behavior and pain during medical procedures because many studies use very small samples and report inconsistent findings.Objectives:To investigate the mean effect sizes across studies for the effects of distraction on young children's distress behavior and self-reported pain during medical procedures.Method:Hunter and Schmidt's (1990)procedures were used to analyze 16 studies (totaln= 491) on children's distress behavior and 10 studies (totaln= 535) on children's pain.Results:For distress behavior, the mean effect size was 0.33 (±0.17), with 74% of the variance accounted for by sampling and measurement error. For pain, the mean effect size was 0.62 (±0.42) with 35% of the variance accounted for. Analysis of studies on pain that limited the sample to children 7 years of age or younger (totaln= 286) increased the amount of explained variance to 60%.Conclusions:Distraction had a positive effect on children's distress behavior across the populations represented in this study. The effect of distraction on children's self-reported pain is influenced by moderator variables. Controlling for age and type of painful procedure significantly increased the amount of explained variance, but there are other unidentified moderators at work.

ISSN:0029-6562    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0029-6562    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background:Interventions that promote positive mother-infant interactions may reduce the risk of poor developmental outcomes for the child.Objective:To examine the effect of infant communication education presented prenatally to first-time mothers on the quality of interaction that occurs between the mother-infant dyad in the first 24 hours following birth.Method:Twenty-nine first-time mothers were randomly assigned to either an intervention or control group. The intervention group received education on infant behaviors, states, and communication cues. A specific mother-infant interaction was videotaped and scored using the Nursing Child Assessment Teaching Scale (NCATS). The scores between groups were compared to determine the effect of education on the interaction that occurred between the dyads.Results:Significant intervention effect was found in the overall totals (t(27)=1.69;p=.05) as well as the contingency scores related to sensitivity to cues (t(27)= 1.93;p= .05) and social-emotional growth-fostering behaviors (t(27)= 1.93;p= .05).Conclusion:A videotaped educational intervention on infant communication implemented prenatally resulted in significant differences between the intervention and control groups on NCATS scores (totals, sensitivity to cues, and social-emotional growth-fostering behaviors). The use of videotaped educational information facilitates very early mother-infant interaction.

ISSN:0029-6562    

出版商:OVID    

年代:1999

数据来源: OVID