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1.
J Trauma Nurs ; 25(2): 131-138, 2018.
Article in English | MEDLINE | ID: mdl-29521782

ABSTRACT

Trauma-informed interventions have been implemented in various settings, but trauma-informed care (TIC) has not been widely incorporated into the treatment of adult patients with traumatic injuries. The purpose of this study was to examine health care provider knowledge, attitudes, practices, competence, and perceived barriers to implementation of TIC. This cross-sectional study used an anonymous web-based survey to assess attitudes, knowledge, perceived competence, and practice of TIC among trauma providers from an urban academic medical center with a regional resource trauma center. Providers (nurses, physicians, therapists [physical, occupational, respiratory]) working in trauma resuscitation, trauma critical care, and trauma care units were recruited. Descriptive statistics summarized knowledge, attitudes, practice, competence, and perceived barriers to TIC and logistic regression analyses examined factors predicting the use of TIC in practice. Of 147 participants, the majority were nurses (65%), followed by therapists (18%) and physicians (17%), with a median 3 years of experience; 75% answered the knowledge items correctly and 89% held favorable opinions about TIC. Nineteen percent rated themselves as less than "somewhat competent." All participants rated the following as significant barriers to providing basic TIC: time constraints, need of training, confusing information about TIC, and worry about retraumatizing patients. Self-rated competence was the most consistent predictor of providers' reported use of specific TIC practices. Despite some variability, providers were generally knowledgeable and held favorable views toward incorporating TIC into their practice. TIC training for trauma providers is needed and should aim to build providers' perceived competence in providing TIC.


Subject(s)
Attitude of Health Personnel , Clinical Competence , Patient Care Team/organization & administration , Trauma Centers/organization & administration , Wounds and Injuries/therapy , Adult , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Health Personnel/education , Humans , Logistic Models , Male , Wounds and Injuries/diagnosis
2.
Matern Child Health J ; 15 Suppl 1: S54-64, 2011 Dec.
Article in English | MEDLINE | ID: mdl-21915679

ABSTRACT

To identify gender differences in correlates of anticipation and initiation of sexual activity in the baseline survey of 562 African-American 5th grade students prior to initiation of a school-based pregnancy prevention intervention curriculum. Students from 16 elementary schools were administered the baseline questionnaire during classroom periods. Using these data, binary and ordered logistic regression models were used to analyze the factors affecting virginity and anticipation of sexual activity separately by gender, and tests of interaction between each factor and gender were conducted on the combined sample. More boys than girls had already had sex (18% vs. 5%) and anticipated having sexual intercourse in the next 12 months (56% vs. 22%). Boys and girls also differed in the factors that affected these outcomes. The perception that their neighborhood was safe reduced the odds that boys anticipated sexual activity but was not associated with this outcome among girls. Pubertal knowledge increased the odds of anticipation, but only among boys. Attitudes favoring abstinence decreased anticipation of sex among both genders, but slightly more among girls than boys. Having more frequent parent-child communication about sex was associated with increased anticipation among girls but decreased anticipation among boys. Curriculum based approaches to adolescent pregnancy prevention are appropriate for 5th grade elementary students who may already be anticipating sexual activity in communities with disproportionate rates of teen pregnancy. The design of the interventions should consider the differences in motivating factors by gender.


Subject(s)
Black or African American/psychology , Black or African American/statistics & numerical data , Child Behavior/psychology , Health Knowledge, Attitudes, Practice , Sexual Behavior/psychology , Sexual Behavior/statistics & numerical data , Adolescent , Child , District of Columbia , Female , Health Knowledge, Attitudes, Practice/ethnology , Humans , Logistic Models , Male , Parent-Child Relations , Pregnancy , Pregnancy in Adolescence/prevention & control , Schools , Sex Distribution , Socioeconomic Factors , Surveys and Questionnaires , Urban Population
3.
Sex Educ ; 11(1): 27-46, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21857793

ABSTRACT

US adolescents initiate sex at increasingly younger ages, yet few pregnancy prevention interventions for children as young as 10-12 years old have been evaluated. Sixteen Washington, DC schools were randomly assigned to intervention versus control conditions. Beginning in 2001/02 with fifth-grade students and continuing during the sixth grade, students completed pre-intervention and post-intervention surveys each school year. Each year, the intervention included 10-13 classroom sessions related to delaying sexual initiation. Linear hierarchical models compared outcome changes between intervention and control groups by gender over time. Results show the intervention significantly decreased a rise over time in the anticipation of having sex in the next 12 months among intervention boys versus control boys, but it had no other outcome effects. Among girls, the intervention had no significant outcome effects. One exception is that for both genders, compared with control students, intervention students increased their pubertal knowledge. In conclusion, a school-based curriculum to delay sexual involvement among fifth-grade and sixth-grade high-risk youths had limited impact. Additional research is necessary to outline effective interventions, and more intensive, comprehensive interventions may be required to counteract adverse circumstances in students' lives and pervasive influences toward early sex.ClinicalTrials. gov identifier: NCT00341471.

4.
J Cardiometab Syndr ; 3(4): 211-7, 2008.
Article in English | MEDLINE | ID: mdl-19040589

ABSTRACT

In the Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial, carvedilol added to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers had neutral or beneficial effects on glycemic measures compared with metoprolol tartrate. For the 1235 diabetic hypertensive GEMINI patients, the authors assessed treatment differences by race (white/black/other), age (continuous variable), and sex on hemoglobin A(1c), insulin resistance (homeostasis model assessment-insulin resistance [HOMA-IR]), and blood pressure. Both treatments significantly reduced blood pressure in all subgroups, but the metabolic effects of carvedilol were more beneficial in subgroups of race and sex. Carvedilol did not affect hemoglobin A(1c) but improved HOMA-IR results in all subgroups, significantly in males and "other race" subgroups. Metoprolol significantly increased hemoglobin A(1c) in all subgroups except "other race," with no effect on HOMA-IR findings. Differences vs metoprolol significantly favored carvedilol for hemoglobin A(1c) in white and female subgroups and favored carvedilol for HOMA-IR in black, "other race," and male subgroups. Carvedilol effects were favorable to adjustment of age as a covariate. In hypertensive patients with diabetes, carvedilol may be a more appropriate choice when beta-blockade is indicated.


Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Blood Glucose/metabolism , Carbazoles/therapeutic use , Diabetes Mellitus, Type 2/epidemiology , Hypertension/epidemiology , Metoprolol/therapeutic use , Propanolamines/therapeutic use , Racial Groups , Adrenergic beta-Antagonists/administration & dosage , Adult , Age Factors , Aged , Aged, 80 and over , Blood Glucose/drug effects , Blood Pressure/drug effects , Carbazoles/administration & dosage , Carvedilol , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Glycated Hemoglobin/drug effects , Glycated Hemoglobin/metabolism , Humans , Hypertension/complications , Hypertension/drug therapy , Insulin Resistance , Male , Metoprolol/administration & dosage , Middle Aged , Prevalence , Propanolamines/administration & dosage , Risk Factors , Sex Factors , Treatment Outcome , United States/epidemiology
5.
Am J Med ; 120(7): 610-5, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17602935

ABSTRACT

PURPOSE: Patients with type 2 diabetes are commonly overweight, which can contribute to poor cardiovascular outcomes. beta-blockers may promote weight gain, or hamper weight loss, and are a concern in high-risk patients. The current analysis of the Glycemic Effect in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial evaluates the effects of carvedilol and metoprolol tartrate on weight gain in patients with type 2 diabetes and hypertension. METHODS: This prespecified secondary analysis of the GEMINI study (n=1106) evaluated change in body weight after 5 months. RESULTS: Mean (+/-SE) baseline weights were 97.5 (+/-20.1) kg for carvedilol and 96.6 (+/-20.1) kg for metoprolol tartrate. Treatment difference (c vs m) in mean (+/-SE) weight change from baseline was -1.02 (+/-0.21) kg (95% confidence interval [CI], -1.43 to -0.60; P <.001). Patients taking metoprolol had a significant mean (+/-SE) weight gain of 1.19 (+/-0.16) kg (P <.001); patients taking carvedilol did not (0.17 [+/-0.19] kg; P =.36). Metoprolol tartrate-treated patients with body mass index (BMI) >30 kg/m2 had a statistically significant greater weight gain than comparable carvedilol-treated patients. Treatment differences (c vs m) in the obese (BMI >30 kg/m2) and morbidly obese groups (BMI >40 kg/m2) were -0.90 kg (95% CI, -1.5 to -0.3; P =.002) and -1.84 kg (95% CI, -2.9 to -0.8; P =.001), respectively. Pairwise correlation analyses revealed no significant associations between weight change and change in HbA1c, HOMA-IR, or blood pressure. CONCLUSIONS: Metoprolol tartrate was associated with increased weight gain compared to carvedilol; weight gain was most pronounced in subjects with hypertension and diabetes who were not taking insulin therapy.


Subject(s)
Adrenergic beta-Antagonists/pharmacology , Antihypertensive Agents/pharmacology , Diabetes Mellitus, Type 2/drug therapy , Hypertension/drug therapy , Adrenergic beta-Antagonists/therapeutic use , Adult , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Body Weight/drug effects , Carbazoles/pharmacology , Carbazoles/therapeutic use , Carvedilol , Double-Blind Method , Female , Humans , Male , Metoprolol/pharmacology , Metoprolol/therapeutic use , Middle Aged , Propanolamines/pharmacology , Propanolamines/therapeutic use , Prospective Studies
6.
Perspect Psychiatr Care ; 43(1): 47-51, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17295858

ABSTRACT

TOPIC: My journey as an Advanced Practice Psychiatric Nurse, aboard the USNS Mercy, providing humanitarian aid to victims of the December 2004 tsunami is the focus of this paper. PURPOSE: To offer insights about healing and recovery that I learned from my time with the victims of this disaster that may be applicable to future disaster situations. SOURCE OF INFORMATION: The author's personal experience of being a volunteer. CONCLUSIONS: My contributions focused on providing mental health care to victims of the tsunami as well as the development of a program of psychosocial intervention and education for children affected by the disaster.


Subject(s)
Adaptation, Psychological , Attitude of Health Personnel , Disasters , Nurse Clinicians/psychology , Volunteers/psychology , Child , Child Welfare , Cooperative Behavior , Disaster Planning/organization & administration , Health Services Needs and Demand , Humans , Indonesia , International Cooperation , Mental Health , Mental Health Services/organization & administration , Nurse Clinicians/organization & administration , Organizational Objectives , Psychiatric Nursing/organization & administration , Relief Work/organization & administration , Ships , United States/ethnology , Volunteers/organization & administration
7.
Am J Cardiol ; 98(7A): 46L-52L, 2006 Oct 02.
Article in English | MEDLINE | ID: mdl-17023232

ABSTRACT

Patients at high risk for hypertension may require several therapeutic agents to lower their blood pressure to guideline-recommended targets. Some antihypertensive agents are more effective than others in protecting against cardiovascular morbidity and mortality. Numerous beta-blocking agents have been approved by the US Food and Drug Administration (FDA) for the treatment of hypertension. Previous trials have demonstrated that although all beta-blockers effectively reduce blood pressure, there are differences in how they affect various metabolic factors. In 2 trials, a novel controlled-release (CR) formulation of carvedilol will be tested against other selective beta-blockers to determine whether differences exist in their individual effects on cardiovascular risk factors. These will be the first head-to-head trials using carvedilol CR to determine whether the differing pharmacologic actions among beta-blockers result in varying effects on cardiovascular risk factors.


Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Carbazoles/therapeutic use , Delayed-Action Preparations/therapeutic use , Dyslipidemias/drug therapy , Hypertension/drug therapy , Hypertrophy, Left Ventricular/drug therapy , Propanolamines/therapeutic use , Adrenergic beta-Antagonists/administration & dosage , Adrenergic beta-Antagonists/adverse effects , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/therapeutic use , Carbazoles/adverse effects , Carvedilol , Delayed-Action Preparations/adverse effects , Drug Therapy, Combination , Dyslipidemias/blood , Dyslipidemias/complications , Humans , Hypertension/blood , Hypertension/complications , Hypertrophy, Left Ventricular/blood , Hypertrophy, Left Ventricular/complications , Hypolipidemic Agents/adverse effects , Hypolipidemic Agents/therapeutic use , Propanolamines/adverse effects , Randomized Controlled Trials as Topic , Research Design , Risk Factors
8.
Hypertension ; 46(6): 1309-15, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16286578

ABSTRACT

Increases in the cardiovascular risk marker microalbuminuria are attenuated by blood pressure reduction using blockers of the renin-angiotensin system. Such changes in microalbuminuria have not been observed when beta-blockers are used. A prespecified secondary end point of the Glycemic Effects in Diabetes Mellitus Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial was to examine the effects of different beta-blockers on changes in albuminuria in the presence of renin-angiotensin system blockade. Participants with hypertension and type 2 diabetes were randomized to either metoprolol tartrate (n=737) or carvedilol (n=498) in blinded fashion after a washout period of all antihypertensive agents except for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Blinded medication was titrated to achieve target blood pressure, with a-5 month follow-up period. The current analysis examined microalbuminuria, using spot urine albumin:creatinine, in participants who had values at screening and trial end. A greater reduction in microalbuminuria was observed for those randomized to carvedilol (-16.2%Delta; 95% confidence interval, -25.3, -5.9; P=0.003). Of those with normoalbuminuria at baseline, fewer progressed to microalbuminuria on carvedilol versus metoprolol (20 of 302 [6.6%] versus 48 of 431 [11.1%], respectively; P=0.03). Microalbuminuria development was not related to differences in blood pressure or achievement of blood pressure goal (68% carvedilol versus 67%, metoprolol). Presence of metabolic syndrome at baseline was the only independent predictor of worsening albuminuria throughout the study (P=0.004). Beta-blockers have differential effects on microalbuminuria in the presence of renin-angiotensin system blockade. These differences cannot be explained by effects on blood pressure or alpha1-antagonism but may relate to antioxidant properties of carvedilol.


Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Albuminuria/drug therapy , Albuminuria/etiology , Carbazoles/therapeutic use , Diabetes Mellitus, Type 2/urine , Metoprolol/therapeutic use , Propanolamines/therapeutic use , Adult , Aged , Aged, 80 and over , Albuminuria/physiopathology , Blood Pressure , Carvedilol , Creatinine/urine , Diabetes Mellitus, Type 2/physiopathology , Double-Blind Method , Female , Humans , Male , Middle Aged , Multivariate Analysis , Randomized Controlled Trials as Topic
9.
J Diabetes Complications ; 19(2): 74-9, 2005.
Article in English | MEDLINE | ID: mdl-15745836

ABSTRACT

Beta-blockers utilized in the Type 2 diabetic patient result in an even greater decrease in cardiac events than in the nondiabetic patient. Unfortunately, first-and second-generation beta-blockers are associated with the worsening of insulin resistance, deterioration of glycemic control, peripheral vasoconstriction, potentially worsening peripheral vascular disease, and more frequent and severe hypoglycemia. The third-generation beta-blockers have unique properties, including alpha1-blockade, and have been shown to lower insulin resistance, improve glycemic control, and vasodilate resistance arterioles. The Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial has been designed to compare a third-generation (carvedilol) with a second-generation beta-blocker (metoprolol) in a cohort of participants with hypertension and Type 2 diabetes. The primary outcome measure of the study is change in the HbA1c. The study is powered to detect a difference in HbA1c of 0.3 units (%) between the groups. Secondary endpoints include changes in insulin resistance, fasting glucose, and the lipid profile. Differences in the side-effect profile (cold extremities, fatigue, impotence, and hypoglycemia) will also be assessed. The GEMINI trial, therefore, is the first large randomized trial to assess whether utilizing a third-generation beta-blocker yields a favorable metabolic profile in the patient with Type 2 diabetes and hypertension.


Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Carbazoles/therapeutic use , Diabetic Angiopathies/drug therapy , Hypertension/drug therapy , Metoprolol/therapeutic use , Propanolamines/therapeutic use , Adult , Aged , Blood Glucose/drug effects , Blood Glucose/metabolism , Carvedilol , Diabetic Angiopathies/blood , Double-Blind Method , Female , Humans , Male , Middle Aged
10.
JAMA ; 292(18): 2227-36, 2004 Nov 10.
Article in English | MEDLINE | ID: mdl-15536109

ABSTRACT

CONTEXT: Beta-blockers have been shown to decrease cardiovascular risk in patients with hypertension and type 2 diabetes mellitus (DM); however, some components of the metabolic syndrome are worsened by some beta-blockers. OBJECTIVE: To compare the effects of beta-blockers with different pharmacological profiles on glycemic and metabolic control in participants with DM and hypertension receiving renin-angiotensin system (RAS) blockade, in the context of cardiovascular risk factors. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, parallel-group trial (The Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives [GEMINI]) conducted between June 1, 2001, and April 6, 2004, at 205 US sites that compared the effects of carvedilol and metoprolol tartrate on glycemic control. The 1235 participants were aged 36 to 85 years with hypertension (>130/80 mm Hg) and type 2 DM (glycosylated hemoglobin [HbA1c], 6.5%-8.5%) and were receiving RAS blockers. Participants were followed up for 35 weeks. INTERVENTIONS: Participants were randomized to receive a 6.25- to 25-mg dose of carvedilol (n = 498) or 50- to 200-mg dose of metoprolol tartrate (n = 737), each twice daily. Open-label hydrochlorothiazide and a dihydropyridine calcium antagonist were added, if needed, to achieve blood pressure target. MAIN OUTCOME MEASURES: Difference between groups in mean change from baseline HbA1c following 5 months of maintenance therapy. Additional prespecified comparisons included change from baseline HbA1c in individual treatment groups, treatment effect on insulin sensitivity, and microalbuminuria. RESULTS: The 2 groups differed in mean change in HbA1c from baseline (0.13%; 95% confidence interval [CI], -0.22% to -0.04%; P = .004; modified intention-to-treat analysis). The mean (SD) HbA1c increased with metoprolol (0.15% [0.04%]; P<.001) but not carvedilol (0.02% [0.04%]; P = .65). Insulin sensitivity improved with carvedilol (-9.1%; P = .004) but not metoprolol (-2.0%; P = .48); the between-group difference was -7.2% (95% CI, -13.8% to -0.2%; P = .004). Blood pressure was similar between groups. Progression to microalbuminuria was less frequent with carvedilol than with metoprolol (6.4% vs 10.3%; odds ratio, 0.60; 95% CI, 0.36-0.97; P = .04). CONCLUSIONS: Both beta-blockers were well tolerated; use of carvedilol in the presence of RAS blockade did not affect glycemic control and improved some components of the metabolic syndrome relative to metoprolol in participants with DM and hypertension. The effects of the 2 beta-blockers on clinical outcomes need to be compared in long-term clinical trials.


Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Antihypertensive Agents/therapeutic use , Carbazoles/therapeutic use , Diabetes Mellitus, Type 2/complications , Glycated Hemoglobin/metabolism , Hypertension/complications , Hypertension/drug therapy , Metoprolol/therapeutic use , Propanolamines/therapeutic use , Adult , Aged , Aged, 80 and over , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Blood Glucose/metabolism , Carvedilol , Diabetes Mellitus, Type 2/blood , Double-Blind Method , Humans , Middle Aged , Renin-Angiotensin System
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