Determinants of functional performance in long-term survivors of allogeneic hematopoietic stem cell transplantation with chronic graft-versus-host disease (cGVHD).

This study examined factors accounting for functional performance limitations in 100 long-term survivors of allogeneic hematopoietic stem cell transplantation with chronic graft-versus-host disease (cGVHD). Functional performance, measured by the SF-36 physical component summary score, was substantially lower (mean=36.8+/-10.7) than the US population norm of 50 (P<0.001). The most severe decrements were in physical function (mean=38.8+/-10.9) and physical role function (mean=37.88+/-11.88); 68% of respondents exceeded the five-point threshold of minimum clinically important difference below the norm on these subscales. Controlling for age and gender, six variables explained 56% of the variance in functional performance: time since cGVHD diagnosis, cGVHD severity, intensity of immunosuppression, comorbidity, functional capacity (distance walked in 2 min, grip strength, and range of motion), and cGVHD symptom bother (F=11.26; P<0.001). Significant independent predictors of impaired performance were intensive systemic immunosuppression, reduced capacity for ambulation, and greater cGVHD symptom bother (P<0.05). Symptom bother had a direct effect on functional performance, as well as an indirect effect partially mediated by functional capacity (Sobel test, P=0.004). Results suggest two possible mechanisms underlying impaired functional performance in survivors with cGVHD and underscore the importance of testing interventions to enhance functional capacity and reduce symptom bother.

Impaired parasympathetic response to feeding in ventilated preterm babies.

BACKGROUND: Premature very low birthweight (VLBW) infants are born with an underdeveloped parasympathetic nervous system (PNS) which may limit their ability to respond adequately to feeding and may limit their capacities for extrauterine growth and development. OBJECTIVES: To describe the patterns of autonomic response to feeding and identify relationships between change in heart period variability measures over time with selected infant characteristics. METHODS: Individual growth curve analysis techniques were used to describe the patterns of change over time in sympathetic and parasympathetic tone as measured by low and high frequency heart period power. RESULTS: Sixteen mechanically ventilated VLBW infants with a mean corrected gestational age of 30.4 weeks participated in the study. The low frequency (LF) power slope was -17.67 (p = 0.0002) and the high frequency (HF) power slope was -0.92 (0.0003). There was a significant relationship between HF slope and birth gestational age (r = -0.49, p = 0.05). CONCLUSIONS: HF power, representing primarily parasympathetic activity, did not increase with enteral feeding as anticipated. LF power, an indicator of sympathetic tone, decreased during and after feeding suggesting the anticipated effect of inhibition of the sympathetic nervous system in response to the gut stimulus. Critically ill VLBW infants possess an overriding sympathetic response, but may not have adequate PNS tone development.

Measurement of parenting self-efficacy and outcome expectancy related to discussions about sex.

The purpose of this study was to evaluate the psychometric properties of two scales--one to measure the self-efficacy of parents to discuss sexual health issues with their adolescents and the other to measure parents' outcome expectancy associated with such discussions. Understanding how parents feel about their confidence in talking with their children about important sexual health issues and the outcomes they expect as a result of such discussions can be useful in guiding both the development and refinement of educational programs to promote parent-child discussions. The responses of 491 mothers who participated in an HIV prevention intervention with their adolescents were used for the present analysis. Mothers ranged in age from 25 to 68 years with a mean of 37.9 years (SD = 6.9). Of mother participants, 33% were married, 96.7% were African American, and 89.2% had completed high school. Their adolescents ranged in age from 11 to 14 years, and 61.5% were male. Assessment of reliability for both scales showed that internal consistency reliability was acceptable for the total scales as well as three of the five subscales. With the exception of one item on the outcome expectancy scale, the inter-item correlations, the mean inter-item correlations, and the item-to-total correlations meet the standard criteria for scale development for both scales. Factor analysis was used to identify the underlying structure of the scales, and hypothesis testing was used to assess construct validity. The results of these analyses provide support for the construct validity of the scales.

Knowledge, attitudes, and interest in breast-ovarian cancer gene testing: a survey of a large African-American kindred with a BRCA1 mutation.

BACKGROUND: This study assessed counseling and testing needs from the perspective of adult members of a large African-American kindred with a BRCA1 mutation. METHODS: Interviews were conducted with 95 male and female kindred members to elicit information on sociodemographics, attitudes toward health care providers, breast cancer screening behaviors, and religious/spiritual beliefs, as well as to evaluate psychological distress, beliefs, knowledge, and attitudes related to genetic testing. RESULTS: Knowledge about breast and ovarian cancer genetics was limited. Adherence to screening recommendations was low among females with no personal breast or ovarian cancer history. The majority (67%) wished to discuss risk factors with a health care provider. Most participants (82%) indicated that they would have a genetic test if it were available. Significant predictors of intent to undergo testing were having at least one first-degree relative with breast and/or ovarian cancer (OR = 5.1; 95% CI = 1.2-20.9) and perceived risk of being a gene carrier > or =50% (OR = 64.3; 95% CI = 5.1-803.9) or reporting that they did not know their risk of being a gene carrier (OR = 10.9; 95% CI = 2.1-57.7). Cited barriers to testing included cost and availability. CONCLUSION: There is a high interest level in genetic testing despite limited knowledge about cancer genetics among these high-risk African Americans. Our study provides information for designing a genetic education and counseling intervention for this and similar families.

A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: results of the Eat for Life trial.

OBJECTIVES: This study reports on Eat for Life, a multicomponent intervention to increase fruit and vegetable consumption among African Americans that was delivered through Black churches. METHODS: Fourteen churches were randomly assigned to 3 treatment conditions: (1) comparison, (2) self-help intervention with 1 telephone cue call, and (3) self-help with 1 cue call and 3 counseling calls. The telephone counseling in group 3 was based on motivational interviewing. The primary outcome, assessed at baseline and 1-year follow-up, was fruit and vegetable intake as assessed by 3 food frequency questionnaires. RESULTS: Change in fruit and vegetable intake was significantly greater in the motivational interviewing group than in the comparison and self-help groups. The net difference between the motivational interviewing and comparison groups was 1.38, 1.03, and 1.21 servings of fruits and vegetables per day for the 2-item, 7-item, and 36-item food frequency questionnaires, respectively. The net difference between the motivational interviewing and self-help groups was 1.14, 1.10, and 0.97 servings for the 2-item, 7-item, and 36-item food frequency questionnaires, respectively. CONCLUSIONS: Motivational interviewing appears to be a promising strategy for modifying dietary behavior, and Black churches are an excellent setting to implement and evaluate health promotion programs.

Social cognitive correlates of sexual experience and condom use among 13- through 15-year-old adolescents.

PURPOSE: To examine the role of self-efficacy, outcome expectancies, and perception of peer attitudes in the delay of onset of sexual activity among 13- through 15-year-old adolescents. We also explored the role of self-efficacy, outcome expectancies, and perception of friends' condom use behavior in explaining the use of condoms among sexually active adolescents. METHODS: This study was part of a larger cross-sectional study to evaluate personal characteristics and maternal factors associated with early initiation of sexual intercourse. Mothers and adolescents were recruited from a community-based organization that offered afterschool and summer programs for youth. Enrollment was limited to adolescents aged 13-15 years and their mothers. Mothers and adolescents completed separate interviews. For adolescents, the interviews included the assessment of the variables in the present study. Each interview lasted about 60 min and was conducted by a trained interviewer. Data were analyzed using descriptive statistics and regression analysis. The average age of the 405 adolescent participants was 13.86 years, and approximately 30% of them had engaged in sexual intercourse. Slightly more than half (56%) of participants were male, and 82% were African-American. RESULTS: Participants who were less likely to believe that their friends favored intercourse for adolescents and who held more favorable attitudes about the personal benefits of abstaining from sex were less likely to have initiated sexual intercourse. Among sexually active adolescents, those who expressed confidence in putting on a condom, and in being able to refuse sex with a sexual partner, and who expressed more favorable outcome expectancies associated with using a condom were more likely to use condoms consistently. CONCLUSIONS: Human immunodeficiency virus and pregnancy prevention programs should emphasize peer influences in both the initiation of sexual intercourse and the use of safer sex practices among sexually active adolescents, as well as personal attitudes about consequences to self and confidence in negotiating safer sex practices with one's partner.

Risk factor distribution among sociodemographically diverse African American adults.

Because African Americans tend to have lower socioeconomic status (SES) than whites and numerous health indicators are related to SES variables, it is important when examining between-group differences in health indices to account for SES differences. This study examined the effects of income and education on several biologic and behavioral risk factors in a sample of sociodemographically diverse African American adults. Approximately 1,000 African American adults (aged 18-87) were recruited from 14 churches with predominantly black membership to participate in a nutrition education intervention. Demographics, height, weight, blood pressure, self-reported cigarette and alcohol use, self-reported diet by food frequency questionnaire, serum carotenoids, serum total cholesterol, and nutrition knowledge were assessed. The association of these risk factors were examined by four levels of education and income. For men, body mass index, blood pressure, total cholesterol, daily intake of fruits and vegetables, serum carotenoids, heavy alcohol use, or exercise were not associated significantly with income or education using analysis of variance (ANOVA). Past month alcohol use and nutrition knowledge were associated positively with education, but not income. For women, body mass index and smoking were associated inversely with income, but not with education. Blood pressure, total cholesterol, intake of fruits and vegetables, heavy alcohol use, and exercise were not associated with either income or education using ANOVA. Serum carotenoids, any 30-day alcohol use, and nutrition knowledge were associated positively with both income and education. Results using linear regression generally were similar for men and women, although a few more variables were associated significantly with SES compared to ANOVA analyses. Several health indicators that have been associated with socioeconomic variables in whites were not associated or only weakly associated in this diverse sample of African Americans. One interpretation of these findings is that SES factors may function differently among blacks and whites.

Validation of three food frequency questionnaires and 24-hour recalls with serum carotenoid levels in a sample of African-American adults.

The validity of self-reported fruit and vegetable intake in minority populations has not been adequately established. In this study, the authors examined the association of three food frequency questionnaires (FFQs) and 24-hour dietary recalls with serum carotenoid levels. Approximately 1,000 African-American adults recruited from 15 churches in Atlanta, Georgia (1997-1998) completed three fruit and vegetable FFQs: a seven-item instrument assessing intake during the past month; a two-item measure assessing usual intake; and a 36-item measure adapted from the Health Habits and History Questionnaire. A total of 414 participants received a 24-hour recall by telephone, and 105 of them received two additional recalls. Serum levels of lycopene, lutein, cryptoxanthin, alpha-carotene, and beta-carotene were assessed in 813 participants and used as the validity criterion. The correlations of fruit and vegetable servings with specific and total serum carotenoid levels were generally higher for the 36-item FFQ than for the two-item and seven-item instruments. The strongest correlation of fruit and vegetable servings with total carotenoid levels was observed for the three recalls (r = 0.42), with the 36-item FFQ and the single 24-hour recall yielding comparable correlations (r = 0.35 and r = 0.37, respectively). The validity of the 36-item fruit and vegetable FFQ was generally as strong as the validity of both 1 and 3 days of recalls. Given the lower cost and time needed for administration relative to recalls, it appears that the 36-item FFQ has merit for evaluating fruit and vegetable health interventions.

Dietary change through African American churches: baseline results and program description of the eat for life trial.

BACKGROUND: Eat for Life, a multicomponent intervention to increase fruit and vegetable (F & V) consumption among African Americans, is delivered through African American churches. METHODS: Fourteen churches were randomly assigned to one of three treatment conditions: 1) comparison; 2) culturally-sensitive multicomponent intervention with one phone call; and 3) culturally-sensitive multicomponent intervention with four phone calls. The intervention included an 18-minute video, a project cookbook, printed health education materials, and several "cues" imprinted with the project logo and a 5 A Day message. A key element of the telephone intervention was the use of motivational interviewing, a counseling technique originally developed for addictive behaviors. Major outcomes for the trial included total F & V intake, assessed by food-frequency questionnaires (FFQs) and 24-hour recalls, and serum carotenoids. Psychosocial variables assessed included outcome expectations, barriers to F & V intake, preference for meat meals, neophobia, social support to eat more F & V, self-efficacy to eat more F & V, and nutrition knowledge. RESULTS: Baseline mean F & V intakes across the three FFQs ranged from 3.45 to 4.28 servings per day. Intake based on a single 24-hour recall was 3.0 servings. Variables positively correlated with F & V intake included self-efficacy, outcome expectations, and a belief that F & V contain vitamins. Factors negatively correlated with intake include perceived barriers, meat preference, neophobia, and high-fat cooking practices. The completion rate for the first telephone counseling call was 90%. Completion rates for the remaining three calls ranged from 79% to 86%. CONCLUSION: The recruitment and intervention methods of the Eat for Life study appear promising. The telephone intervention based on motivational interviewing is potentially useful for delivering dietary counseling.

Correlates of safer sex communication among college students.

Correlates of safer sex communication among college students The purpose of this study was to examine factors that are thought to promote communication about safer sex and HIV among college students in the United States of America and to determine the extent to which communication about safer sex is important in the use of condoms. A better understanding of factors associated with safer sex communication can be helpful in developing HIV and STD prevention programmes for college students. Following approval from the institutional review boards of the six participating colleges and universities, researchers collected data from a random sample of students. The study included participant responses if participants were 18-25 years of age, single and sexually active. For the sample of 1349 participants, the mean age was 20.6 years. Sixty-three per cent of the sample was female, 50.5% white, 42.3% African-American, and the remainder of other ethnic groups. Over 50% of respondents reported frequent condom use, with 28% noting that they used a condom every time and 30.6% reporting condom use almost every time they had sex. Only 9.6% indicated that they never used a condom. The results of hierarchical multiple regression analysis revealed that the perception of quality of general communication with parents, the perception of a partner's attitude towards communication, communication self-efficacy, and communication outcome expectancies, were associated with safer sex communication. However, the association between safer sex communication and condom use was weak, suggesting that other factors excluded from this study are important in determining condom use for this sample of respondents. The findings provide some implications for HIV interventions. Interventions that enhance self-efficacy and positive outcome expectancies related to communication about safer sex are likely to foster discussion with a sexual partner. However, they might not lead to actual condom use.

A social cognitive-based model for condom use among college students.

BACKGROUND: Social cognitive theory has been used extensively to explain health behaviors. Although the influence of one construct in this model-self-efficacy-has been well established, the role of other social cognitive constructs has not received as much attention in human immunodeficiency virus (HIV) prevention research. More complete understanding of how social cognitive constructs operate together to explain condom use behaviors would be useful in developing HIV and sexually transmitted disease (STD) prevention programs for college students. OBJECTIVE: The primary aim of this study was to test a social cognitive-based model of condom use behaviors among college students. METHODS: Data were collected from a sample of college students attending six different colleges and universities. Participants were 18 to 25 years of age, single, and sexually active. For the sample of 1,380 participants, the mean age was 20.6 years (SD = 1.76). Most participants reported having had vaginal intercourse (95.8%) and oral sex (86.5%); 16% reported anal sex. FINDINGS: Self-efficacy was related directly to condom use behaviors and indirectly through its effect on outcome expectancies. As predicted, self-efficacy was related to anxiety, but anxiety was not related to condom use. Substance use during sexual encounters was related to outcome expectancies but not to condom use as predicted. CONCLUSIONS: Overall, the findings lend support to a condom use model based on social cognitive theory and provide implications for HIV interventions. Interventions that focus on self-efficacy are more likely to reduce anxiety related to condom use, increase positive perceptions about condoms, and increase the likelihood of adopting condom use behaviors.

Social cognitive factors associated with mother-adolescent communication about sex.

To better understand why some mothers talk to their children about sex and others do not, we examined the role of two social cognitive variables--self-efficacy and outcome expectancies--in explaining sex-based communication. The present study was part of a larger study to test the efficacy of two HIV prevention programs for mothers and their adolescents. Mothers and their adolescents were recruited from a large community organization that serves youth who live in disadvantaged circumstances. The sample for the present study included 486 mothers who averaged 38.4 years of age (SD = 6.73). The majority were African American (97.7%), not married (66.7%), and had a high school degree (89.5%). Their adolescents ranged in age from 11 through 14 years of age and most were male (61.3%). The results of the analysis revealed that mothers who expressed higher levels of self-efficacy and more favorable outcomes associated with talking to their children about sex were more likely to do so. In a regression analysis, we learned that the mother's degree of efficacy beliefs, along with her expected outcomes associated with talking about sex, the importance of religious beliefs to her, and the age and sex of her adolescents were important factors associated with talking with them about sex.

An evaluation of a self-generated identification code.

We describe a self-generated coding form used in a study of HIV prevention practices of college students and provide information on the success rate of matching questionnaires over a 3-year period using the form. The data for this study were from a longitudinal study of HIV risk-reduction practices of college students. In order to match questionnaires over the 3-year study period while maintaining anonymity, participants were asked to complete a self-generated identification form at each data collection point. In the second year of the project, we were able to successfully match 74.3% of the questionnaires to those returned during the first year using 6 to 8 of the code elements on the form, and in the third year, we were able to match 73% of questionnaires to those returned in the second year. Participants for whom questionnaires matched were more likely than participants with unmatched questionnaires to be white students enrolled as underclassmen.

Factors associated with outcomes 3 months after implantable cardioverter defibrillator insertion.

BACKGROUND: Adjustment to living with an implantable cardioverter defibrillator (ICD) is a dynamic process that varies among individuals. The purpose of this study was to describe patterns of recovery and to examine the relationships among demographic and clinical factors, illness appraisal and coping behaviors, and outcomes of physical and emotional function in the early recovery period of the first 3 months after initial ICD insertion. METHODS: Data were collected in the acute care setting and again at 1 and 3 months after ICD insertion. Subjects were 213 patients (83% men), ages 24-85 (mean 59.6) years. Demographic and clinical variables representing personal and situational factors, illness appraisal, and coping variables were examined using hierarchical multiple-regression analyses to predict outcomes of mood disturbance and functional status. RESULTS: The data revealed that symptoms, illness appraisal, and coping behaviors significantly explained additional variance in both functional status and mood disturbance above that accounted for by the less modifiable demographic and clinical variables. CONCLUSIONS: Symptoms, illness appraisal, and coping behaviors were predictors of outcomes in ICD patients. These factors are modifiable aspects of the recovery process, and interventions aimed at symptom management, appraisal reframing, and coping training should be tested to improve mood and functional outcomes for ICD patients.

The effects of ethnicity and perceived power on women's sexual behavior.

PIP: This study examined differences in sexual attitudes and behavior among women who described themselves as dominant in their relationship with a male partner, sharing equal dominance with a male partner, or being dominated by a male partner. Data from 615 White and African American college women (aged 18-25) in the US were analyzed. Results indicate that women who perceive their partner as dominant in their relationship may have more difficulty with the interpersonal aspects of safer sex behavior than women who see themselves as equal or dominant. These women had significantly lower levels of confidence in their abilities to negotiate sex and discuss the use of condoms successfully. They also expressed greater fear of the negative consequences of engaging in these interpersonal behaviors. Examinations in the context of racial differences showed that African American women had higher rates of personal empowerment and safer sex behavior than White women. However, perceived dominance did not appear to affect African American and White women differently. Thus, HIV prevention programs targeting women should incorporate discussions on the effects of power in relationships on women's sexual behavior, sexual assertiveness, and communication skills training.^ieng

Acute oral pain and mucositis in bone marrow transplant and leukemia patients: data from a pilot study.

The purposes of this prospective, repeated-measures descriptive pilot study were to describe patterns of acute oral pain and mucositis in patients receiving a bone marrow transplant or high-dose chemotherapy for leukemia, and to test procedures and instruments before initiating a larger intervention study. A nonprobability, purposive selection process was used to enroll 18 patients admitted to two acute care inpatient hospital units for bone marrow transplantation or leukemia therapy at a university health sciences center in the southeastern United States. Data were collected at baseline, then daily through patient interviews, oral examination, and chart review for at least 3 weeks or until discharge. Research variables were pain intensity, intolerable pain, verbal descriptors of pain, pain relief, and use of pain relief strategies (Pain Assessment Form), mucositis (erythema and ulceration) in eight anatomic locations of the oral cavity (Oral Mucositis Index), voice/talking (Oral Assessment Guide), and mood states (11-item Brief Profile of Mood States). Mild to moderate pain occurred in nearly 70% of patients and was described as "tender," "irritating," and "sore." Patients used pain medicines, mouth care, and mental and physical activities to relieve pain, and reported partial overall relief of pain. Mucositis was mild, with the tongue and buccal and labial mucosa most commonly affected with erythema and the buccal mucosa with ulceration. Voice/talking were only mildly impaired, and mood disturbance was mild. Patterns of pain, mucositis, and mood disturbance were consistent with each other and followed the trajectory described in previous research. Results suggest that nurses should continue to assess these symptoms vigorously and assist patients in selecting multiple management strategies. Research using repeated-measures designs in this acutely ill inpatient population is challenging and needs careful attention by researchers. The results have been used to improve the ongoing larger intervention study.

Women's self-reported condom use: intra and interpersonal factors.

In the past several years, the greatest proportionate increase in AIDS diagnoses has occurred among women. Yet, while the risk of HIV infection increases, female college students continue to report inconsistent HIV prevention behaviors. Past research on condom use among college women has focused on intrapersonal aspects of the behavior, and little is known about the influence of interpersonal factors on women's condom use. In this study we examined the relative salience of both intra and interpersonal factors on African American and white women's use of condoms. We found that interpersonal variables were particularly salient predictors of condom use. There were no ethnic differences in the effects of interpersonal variables; however, there were differences in the effects of self-efficacy on condom use.

PIP: The relative importance of intrapersonal and interpersonal factors on women's condom use was assessed in a cross-sectional study of 762 sexually active female students (mean age, 20.5 years) from 6 colleges and universities in Atlanta, Georgia (US), who had never married and were not currently living with a partner. 354 respondents were White and 408 were Black. Measures were taken of self-efficacy for condom use; perceived partner reactions to condom use and self-evaluative outcome expectancies; perceived partner attitudes toward condoms; and condom use. After controlling for race, partner attitude toward condoms was the most salient predictor of actual condom use; this variable explained 17% of the variance. For White women only, higher self-efficacy was associated with increased condom use; however, self-efficacy explained only 2% of the overall variance. These findings confirm the importance of interpersonal variables in influencing both Black and White women's condom use.

Nurse practitioners: meeting the ED's needs.

Results of a descriptive analysis of emergency-department (ED) census data were used as a basis for initiating an innovative nurse practitioner (NP) position. In establishing the NP role, census levels, demographic considerations, legal considerations and scope of practice were considered.

Nursing faculty development during a time of declining resources.

During a time of declining resources, a school of nursing faculty development committee and their Dean devised a way to provide need-specific scholarly development programs using principles of human potential development. The process yielded information useful for faculty development, regardless of economic resources. Faculty were invited to participate in a non-confidential survey that assessed their needs for scholarly productivity, resources they would offer to others, and goals for their own development. The list of resources and needs generated was shared with faculty. Based upon the needs and resources identified, specific development activities were initiated. Six workshops were planned and implemented with high (89%) participation. The dean hired a part-time statistician, a faculty member developed and distributed a handout on "Tips for Time Management," and a writers' support group was formed. This approach to faculty development merits consideration by other groups since it focuses upon the synergistic development of human potential.