Metabolic crisis: hyperemesis gravidarum.

Nausea and vomiting during pregnancy affect approximately 50% to 70% of all pregnant women. Although most cases of nausea and vomiting in pregnancy resolve spontaneously and are not associated with compromised nutritional status, a small percentage of cases progress to hyperemesis gravidarum (severe nausea and vomiting during pregnancy). Hyperemesis gravidarum is a serious disorder that can lead to weight loss, dehydration, electrolyte disturbances, and occasionally death if improperly treated or left untreated. The article summarizes recent research on hyperemesis gravidarum, focusing on the definition, etiology, epidemiology, and current treatment of symptoms.

Self-efficacy and confidence in outcomes as determinants of self-care practices in inner-city, African-American women with non-insulin-dependent diabetes.

The purpose of this study was to examine the extent to which perceived self-efficacy and confidence in outcomes, selected demographic variables, and disease characteristics (age, duration of diabetes, presence of documented complications) affect an individual's adherence over time to a diabetes regimen of home glucose testing, medication/insulin administration, diet, and exercise. A convenience sample of 118 inner-city, African-American women with type II, non-insulin-dependent diabetes mellitus receiving outpatient care at a large urban hospital were asked to complete measures of each of the psychosocial variables on two occasions, separated by an interval of 4 to 5 months, and coinciding with their next scheduled clinic visit. Bivariate and multivariate analyses at Times 1 and 2 demonstrated the ability of self-efficacy alone to explain diet, exercise, and home-testing behaviors while suggesting variability within individuals in sense of self-efficacy over time.

Occupational exposure to extreme temperature and risk of testicular cancer.

A study of 250 patients with pathologically confirmed testicular cancer diagnosed between January 1977 and June 1980 and 250 population controls matched for age and residence was carried out to investigate risk factors for testicular cancer. This paper reports results of risk associated with occupational exposure to extreme (< or = 60 degrees F or > or = 80 degrees F), high (> or = 80 degrees F), and low (< or = 60 degrees F) temperature. Interviews of approximately 1.5 h duration were conducted by trained male interviewers, using a standardized interview schedule. Mantel-Haenszel methods and logistic regression models were employed to estimate these temperature effects on risk of testicular cancer. The estimated adjusted odds ratios of testicular cancer, when 16 potential confounders were controlled for, were 1.71 (95% Cl: 1.13-2.60) for occupational exposure to extreme temperatures; 1.70 (1.04-2.78) for low temperature; and 1.20 (0.80-1.80) for high temperature. The findings suggest that occupational exposure to extreme, low, and high temperature may increase risk of testicular cancer, independent of other potential risk factors.

Evaluating quantitative research designs: Part 1.

This article has provided an overview of the three major types of quantitative designs commonly used in nursing research, as well as some criteria for evaluating the designs of published research. The next column will include additional criteria for critiquing quantitative research designs.

A longitudinal study of nurses' attitudes toward caring for patients with AIDS in Erie County.

The purpose of this study was to examine nurses' attitudes toward caring for patients with AIDS in a longitudinal context. Results of the 1990 survey were compared with those of a survey conducted in 1986 for the purpose of examining changes in attitudes over time. Findings indicated that there were no significant differences between the 1986 and 1990 scores on the attitude scales. The results of the study indicated that many nurses still have fears and concerns about caring for patients with AIDS.

Smoking, alcohol, dentition and diet in the epidemiology of oral cancer.

This matched case-control study was conducted in Western New York. The smoking, alcohol consumption, dental hygiene and diet of 290 cases were compared with those of 290 sex-, age-, and neighbourhood-matched controls. The results confirm earlier findings that cigarette smoking and alcohol consumption impart substantial risk of oral cancer. The results also confirm that poor oral hygiene increases the risk of oral cancer, although this effect is much smaller than those of cigarette smoking and alcohol consumption. The results suggest that, of macronutrients, intake of fat is more likely than those of protein or carbohydrate to be related to risk. Of micronutrients, calcium, sodium, riboflavin and retinol are associated with risk, while thiamin, niacin, and dietary fibre are associated with decreased risk. Although patterns of dietary effects are discernable, these effects are in general much weaker than are those of smoking and alcohol consumption.

Alcohol consumption and lung cancer in white males.

Experimental and epidemiologic investigations in alcoholic and nonalcoholic populations have suggested a role of alcohol in lung carcinogenesis. The association between alcohol consumption and lung cancer was investigated among 280 White males with histologically confirmed, primary lung cancer and 564 White male controls, participants in the Western New York Diet Study (United States). Among heavy smokers (over 40 pack-years), total alcohol consumption was associated with an increased risk of lung cancer with adjustment for age, years of education, pack-years of cigarette smoking, and intake of carotenoids and fat. In this group, the odds ratio for drinkers of more than 24 drinks per month was 1.6 compared with those who drank less. Drinkers of more than 12 beers per month were 1.6 times more likely to develop lung cancer than nondrinkers of beer after controlling for age, years of education, and cigarette smoking (95 percent confidence interval = 1.0-2.4, P for trend = 0.003). Occupational and dietary factors did not seem to explain these findings. Although cigarette smoking is the major cause of lung cancer, the role of alcohol, independent or in interaction with cigarette smoking, deserves further investigation.

Evaluating quantitative research problems.

By focusing on criteria for evaluating quantitative research problems and by understanding their evolution from prior research and their placement within a theoretical context, nurses should realize that good research depends to a great degree on good questions. Unless an investigator has a "good, workable, significant topic, the most carefully and skillfully designed research project will be of no value.

Health practices of critical care nurses.

Little is known about the health practices of critical care nurses (CCNs). Because their health behaviors may influence their inclinations to counsel patients, it is important that CCNs engage in a healthy lifestyle and serve as health exemplars. The purpose of this survey was to describe the health practices of 499 CCNs. Data were gathered by questionnaires that elicited information regarding smoking habits, oral health and dietary practices, energy expenditure, seat belt use, alcohol consumption, and health surveillance behaviors. This article is a sequel to a previous manuscript that reported findings relative to the smoking practices of CCNs. Results of the study suggest that the CCNs surveyed were not fulfilling their roles as health exemplars. Although some reported favorable health practices, many indicated habits that were less than desirable. These data document the need to develop strategies for improving the health behaviors of CCNs, thereby protecting their future health. Ultimately, these strategies may benefit their patients.

Diet, smoking, and alcohol in cancer of the larynx: a case-control study.

A case-control study among white men in western New York was conducted from 1975 through 1985 to examine diet and other risk factors for laryngeal cancer. Incident pathologically confirmed cases (250) and age- and neighborhood-matched controls (250) were interviewed to determine usual diet and lifetime use of tobacco and alcohol. Cigarettes were strongly associated with risk; pipes and cigars were not. Beer and hard liquor but not wine were associated with increased risk. Dietary fat and carotenoids were related to risk in opposite ways. The upper quartile odds ratio for dietary fat was 2.40 [95% confidence interval 1.26, 4.55], and the upper quartile odds ratio for carotenoids was 0.51 (0.26, 1.01). There was effect modification by smoking. Carotenoids were most negatively associated with risk among the lightest smokers, whereas dietary fat was most positively associated with risk among the heaviest smokers. Total calories, protein, and retinol were associated with increased risk; there was no relationship between laryngeal cancer and vitamin C, vitamin E, carbohydrate, or dietary fiber. This study again demonstrates the strong association between tobacco and alcohol and laryngeal cancer and also suggests that diets low in carotenoids and high in fat may increase risk.

Chemical impairment in colleagues: perceptions of Western New York nurses.

The purpose of this study was to determine nurses' perceptions about substance abuse in professional colleagues, opinions about strategies for dealing with substance abuse, and knowledge about resources available for dealing with the problem of chemical impairment. Subjects included a convenience sample of 161 nurses from Western New York. Data were gathered by a questionnaire that included "The Perceptions of Nursing Impairment Inventory" and items regarding respondents' background characteristics, suspicions about alcohol and drug abuse in nurse colleagues, and knowledge about and use of peer assistance services available through District I of the New York State Nurses Association. The major outcome of the study was identification of a knowledge deficit on the extent of the substance abuse problem in nursing, ability to recognize an impaired colleague, and awareness of services available. These data substantiate the need for implementing educational programs to increase nurses' basic knowledge of, and sensitivity to, the problem of chemical dependency.

Folate intake and carcinogenesis of the colon and rectum.

Experimental evidence suggests that folate depletion plays a role in carcinogenesis. A case-control study examining folate intake was conducted. Some 428 colon and 372 rectal cancer cases with matched neighbourhood controls were interviewed regarding usual intake of foods, including food preparation. Unadjusted folate was not associated with risk of either cancer. Controlling for kilocalories, odds ratios (ORs) for those with the highest folate intake were 0.5 (95% confidence interval (CI): 0.24-1.03) and 0.31 (95% CI: 0.16-0.59) for females and males for rectal cancer. There was no change in colon cancer risk associated with folate intake. There was an indication of an interaction of folate and alcohol intake; the difference in risk associated with low and high folate intake was highest for males in the highest alcohol category. Associations were of similar magnitude for other dietary factors correlated with folate. It appears that intake of folate or a correlated factor may be negatively related to risk of rectal cancer.

Predictors of attempting and succeeding at smoking cessation.

This paper presents results of a prospective study which examined factors influencing self-initiated smoking behavior change in a cohort of smokers followed over 17 months. Employees of a cancer hospital and research center were surveyed about smoking habits, health status, attitudes about smoking and social-environmental factors. Seventeen months later, employees identified as smokers were resurveyed about their current smoking status, recent attempts at cessation and use of cessation aids in these attempts. Overall, 47% of subjects had not tried to stop smoking (non-stoppers, NS), 38% had attempted to quit but returned to smoking (recidivists, R) and 15% had successfully quit (SQ). Predictors of attempting cessation (R and SQ versus NS) included smoking fewer cigarettes daily, starting smoking at a later age, previous attempts at quitting, lower nicotine dependence, greater pressure to stop smoking and an expectation to quit in the near future. Amount smoked daily was the strongest predictor of successful quitting (SQ versus R). Findings from this study suggest intention to stop smoking is the most important factor differentiating smokers who attempt cessation from those who do not. Strength of smoking habit appears to be the strongest factor associated with successful quitting.

AIDS and homophobia among nurses.

The purpose of this research was to study nurses' attitudes toward homosexuality and caring for homosexual patients. The results reported in this article are a component of a larger study of nurses' knowledge about and attitudes toward caring for patients with AIDS. The sample comprised 581 Registered Nurses residing in Erie County, New York. Data were gathered by mailed questionnaires. Results of the study indicate that issues concerning the care of patients with AIDS may be complicated by the fact that many of these individuals are homosexuals. The results of this research provide data for developing intervention strategies to help nurses cope with their concerns about caring for homosexual patients with AIDS.

Risks associated with source of fiber and fiber components in cancer of the colon and rectum.

In this case-control study, we examined the food sources of fiber and fiber solubility to determine whether particular components of dietary fiber were differentially associated with risk of colon and rectal cancer. In Western New York, cases with pathologically confirmed, single, primary cancers of the colon and rectum as well as age-, sex- and neighborhood-matched controls were interviewed from 1975-1986. The sample included 428 colon case-control pairs (223 females, 205 males) and 422 rectal case-control pairs (145 females, 277 males). Subjects were interviewed regarding usual quantity and frequency of consumption of foods. For the colon, risk decreased with intake of grain fiber for both females and males and with intake of fruit/vegetable fiber for males only. Insoluble grain fiber was more strongly associated with risk than soluble grain fiber. For the rectum, fruit/vegetable fiber was associated with decreased risk, whereas grain fiber was not. There was no difference in risk for soluble and insoluble fiber components for the rectum. Analysis of risk associated with fiber by food source and by components of the fiber may provide insight into possible mechanisms of a fiber effect on cancer of the colon and rectum.