Worry and bother: factors in rural women's health decision making.

This exploratory study examined older rural women's health decision making. Thirty-three rural women were recruited to participate in semistructured qualitative interviews. Major themes emerged that focused on rural women's comments regarding their concerns about not worrying or bothering their children with personal health matters. Themes were discussed in the context of an ethic of care. Results suggest that it is important for mental health professionals, family physicians, social workers, and other practitioners to be aware of the sense of worry and concern for others that older rural women bring to bear in decision making about personal health issues.

'Heart attack' symptoms and decision-making: the case of older rural women.

INTRODUCTION: Women are just as vulnerable to 'heart attacks' (used throughout this study to mean 'myocardial infarction') as men and are often unaware of many associated symptoms. Researchers have illustrated that women have difficulty identifying the symptoms of cardiovascular disease, with patients often delaying treatment after the onset of symptoms. Some individuals wait hours or even days before seeking medical care. This is particularly concerning for older rural women because the rates of death from cardiovascular disease and cancer are higher in some rural areas. Despite idealistic views of country life as being active, less stressful, and possessing strong social and community support, rural Americans are more likely than their urban counterparts to face challenges to maintaining health.
AIM: The purpose of this paper is to utilize information gathered from a qualitative study exploring older rural women's identification of symptoms and health decision-making specific to heart attack vignettes. METHODS: Snowball sampling was the main approach utilized to access participants; after an initial contact was successful, participants contacted additional older rural women to see if they might be willing to participate in an interview. This resulted in a final sample of 33 women who resided in rural Midwestern areas of the USA, were 65 years or older, lived in a county defined as rural by the US Census, and were willing to participate in a face-to-face interview. Each interview included a demographic questionnaire, a health questionnaire, and three health vignettes with follow-up questions. Vignettes provided a way of initiating discussions about health decisions without invading the privacy known to be important to rural residents. The term 'heart attack' was used in the interviews because it was thought to be better recognised than the medical term 'myocardial infarction'. All data were audio taped, transcribed, and coded using line-by-line coding. Data were analyzed using content analysis. RESULTS: The study showed that women had difficulty identifying heart attack symptoms when they did not have previous exposure to the symptoms either through personal experience or educational programs. Individuals incorrectly identified symptoms of a heart attack by associating symptoms with sleep problems, stroke, arthritis, stiffness in the neck, influenza, nerve damage, osteoporosis, bone cancer, tooth infection, and a pulled muscle. Misdiagnosis of symptoms most often led to a delay in seeking treatment in these women. Additionally, the women in this study discussed a reluctance to access care because of concerns related to maintaining their privacy, belief that the ambulance would take too long to reach them, and they did not want to bother their relatives for help. CONCLUSIONS: The findings of this study suggest implications for educational programs and interventions in rural environments and provide information that can facilitate better-informed communication between healthcare professionals and rural women.

Predictors of the prevalence of bacterial STI among young disadvantaged Indigenous people in north Queensland, Australia.

OBJECTIVE: To identify sexually transmitted infections in rural and remote Indigenous communities in north eastern Australia and examine factors that may influence prevalence. METHODS: A cross sectional survey of 26 Aboriginal and Torres Strait Islander communities in northern Queensland was carried out. 3313 people (2862 Indigenous) aged 15 years and over resident in participating communities during the period March 1998 to December 2000. The main outcome measures were community and population prevalence of chlamydia and gonorrhoea and independently associated risk factors. RESULTS: A total of 238 cases of chlamydia, 66 cases of gonorrhoea, and 37 cases of co-infection were detected among Indigenous participants. Prevalence of chlamydia and/or gonorrhoea ranged from 23.0% among 15-19 year olds to 3.5% among those 40 years and older. In the adjusted analysis younger age, female sex, lower socioeconomic status, the use of alcohol and tobacco, and the structure of community health services were independently associated with a higher prevalence of bacterial STI. CONCLUSION: This study highlights the need for improved STI control in north Queensland Indigenous communities through strategies to improve the reach and accessibility of primary healthcare services.

Amyotrophic lateral sclerosis and hopelessness: psychosocial factors.

The purpose of this study was to investigate the relationship of psychosocial factors to the presence of hopelessness among patients with amyotrophic lateral sclerosis (ALS). Secondary cross-sectional analyses were conducted with data collected from 136 ALS patients. Primary research questions were examined using hierarchical multiple regression procedures. Results showed that health locus of control and purpose in life were significant predictors of hopelessness among ALS patients. Other factors, including socioeconomic and demographic variables, variables measuring length and severity of illness, and additional psychosocial variables (social support satisfaction and degree to which spiritual beliefs help to cope with ALS) were not significant predictors of hopelessness. Results are discussed in light of the benefit to ALS patients of psychosocial interventions in disease management.

The clinical spectrum of postpartum thyroid disease.

The clinical and biochemical features of postpartum thyroid disease were analysed in 152 antithyroid peroxidase antibody-positive (anti-TPO+ve) women and compared with 239 anti-TPO-ve age-matched control postpartum women. All were assessed monthly for up to 12 months postpartum. Seventy three anti-TPO+ve women developed postpartum thyroiditis (PPT): 19.2% hyperthyroid alone, 49.3% hypothyroid alone, and 31.5% characterized by hyper- followed by hypothyroidism. None of the antibody-negative women developed any thyroid dysfunction. A significant increase in many of eleven symptoms of hypothyroidism and some of eight symptoms of hyperthyroidism compared to control women was observed in all anti-TPO+ve women, independent of thyroid status. This was particularly seen in women who later developed PPT when they were euthyroid, but was also observed in euthyroid anti-TPO+ve women who showed no decline of thyroid function during the postpartum period. Although PPT is usually transient, this condition, and the euthyroid antibody-positive state, may be associated with significant symptomatology, including an increased incidence of minor to moderate depression. Early recognition of this syndrome by antenatal screening of thyroid antibodies may contribute to improved management of women during the postpartum period.

Identification of a case of maternal uniparental disomy of chromosome 10 associated with confined placental mosaicism.

We report a case of maternal uniparental disomy of chromosome 10 discovered after chorionic villus sampling (CVS). Direct preparations revealed mosaic trisomy 10, while cultured CVS cells, as well as amniotic fluid cells, showed only a normal 46,XY complement. DNA analysis using microsatellite markers showed both chromosomes 10 to have been inherited from the mother. The pregnancy was complicated by polyhydramnios. A phenotypically normal male infant of appropriate size was delivered by Caesarean section at 41 weeks' gestation. Since only the direct preparations showed trisomy 10, this case illustrates the importance of CVS direct preparations in the detection of pregnancies at risk of uniparental disomy (UPD). Although the increased frequency of confined placental mosaicism (CPM) diagnosed when direct preparations are performed has been viewed negatively, identification of both CPM and UPD may have biological and clinical significance for a pregnancy. Even though only a single case of maternal disomy 10 is reported here, the apparently normal phenotype provides evidence that there are no major imprinted loci on chromosome 10 that affect in utero growth and development. However, other potential effects such as mental retardation will require long-term follow-up of this as well as additional cases.

Examination of the factor structure of the Ways of Coping Questionnaire with clinical populations.

The purpose of this study was to examine the construct validity of the Ways of Coping Questionnaire in a clinical population. The questionnaire, designed to measure coping behaviors in a community-residing well population, contained eight empirically constructed factors. Confirmatory factor analysis with LISREL was used to validate this original eight-factor model with 655 community-residing adults with multiple sclerosis or a spinal cord injury. The hypothesized model was not a good fit to the data. Subsequent analyses, using both exploratory and confirmatory factor analysis procedures, identified three different coping factors: Cognitive Reframing, Emotional Respite, and Direct Assistance. These factors appeared to have greater applicability to people with chronic conditions. The kinds of coping behaviors used to manage stressful situations by individuals who are well may be quite different from those used by community-residing populations with long-term chronic conditions.

Conjugal support: factor structure for older husbands and wives.

The purpose of this study was to investigate the factor structure of social support among older spouses. The sample consisted of 298 older marital dyads who participated in the Aging Couples Study. Confirmatory factor analysis techniques were used to examine conjugal support in a series of nested measurement models at the couple and individual levels. Two research questions were addressed: (a) the viability of conjugal support as a couple's construct, and (b) the dimensionality of social support within the marital dyad. Results showed that conjugal support was a husband/wife, rather than a couple, construct. Findings also showed that conjugal support was a multidimensional construct consisting of three factors: instrumental support, emotional support, and confiding. Moreover, husbands and wives perceived the dimensions of conjugal support differently.

McDonald cerclage under pudendal nerve block.

OBJECTIVE: The purpose of our study was to evaluate McDonald cerclage placement with pudendal anesthesia. Patient pain and hospital charges were analyzed and compared with a control group. STUDY DESIGN: This was a prospective, nonrandomized study. Pain was evaluated with a visual analog scale. Two groups were compared with the Student t test. RESULTS: Of 69 patients, 20 had cerclage with pudendal anesthesia; 49 served as control and had cerclage with regional anesthesia. There were no statistical differences in pain between the two groups or complications from pudendal anesthesia, and there was a large cost savings. CONCLUSION: All 20 patients had McDonald cerclage placed successfully with pudendal anesthesia. McDonald cerclage can be easily and safely placed under pudendal anesthesia, resulting in cost savings and improved use of time and resources for the patient and her physician.

Older rural nonsurvivors: their prediction and terminal care.

This research reports on nonsurvivorship by comparing two groups of older rural adults: 138 survivors and 45 nonsurvivors from the third wave of a longitudinal study. They were part of a sample of 418 adults aged 65 and older, first interviewed in 1976. The purposes of these analyses were to examine (a) the predictors of nonsurvivorship to very old age, (b) the final health crises of rural nonsurvivors, and (c) the formal and informal supports addressing their terminal health needs. Average age at death was 83. Results showed that only minimal variance in nonsurvival to very old age could be predicted using standard demographic and psychological variables. The relative importance of predictors varied according to time of measurement (age). Terminal illnesses were similar in type to those of the general aging population. Final illnesses were usually multiple and lengthy, and deaths seldom occurred in the older rural adults' county of residence. Families usually cared for older members without the assistance of formal supports except for a physician, who usually lived out of the county or in the adjoining state. Implications for practitioners are discussed.

Gender and race: an interaction affecting the replicability of well-being across groups.

The Life Satisfaction Index (LSI) continues to be one of the most frequently used measures of well-being in social gerontology. Discrepancies in the operational use of the LSI, however, have made comparisons across studies difficult. Few studies have incorporated examination of the effect of gender/race interactions on the performance of the LSI. The purpose of this study was to examine differences in the hierarchical factor structure of life satisfaction among four gender/race groups using previously reported item pools and coding schemes. Three second-order, three-factor life satisfaction models were examined using confirmatory factor analysis techniques with four groups of older adults: White men (n = 846), White women (n = 1341), Black men (n = 177), and Black women (n = 287). In general, results showed differences in LSI factor structure across gender/race groups. With regard to coding scheme, models using Neugarten et al.'s original coding scheme (1961) and those using Wood et al.'s alternative scoring (1969) were similar. Examination of models using different LSI item pools showed that the factor structure of life satisfaction was affected by the gender/race interaction, underscoring the problem of misspecification resulting from the sum of LSI items and use of the summated score as a unidimensional measure of well-being. Implications for future research are discussed.

A longitudinal investigation of the factor structure of subjective well-being: the case of the Philadelphia Geriatric Center Morale Scale.

The purpose of this research was twofold: (a) to replicate the hierarchical factor structure of well-being with rural data; and (b) to investigate the longitudinal invariance of this factor structure. Subjective well-being was hypothesized to have a hierarchical factor structure with a second order factor, well-being, explaining variance in first order dimensions labeled agitation, lonely dissatisfaction, and attitude toward one's aging. The latent constructs were measured by items composing the PGC Scale (Lawton, 1975). Maximum likelihood confirmatory factor analysis techniques were used to test the fit of the model. Subjective well-being was investigated using a panel of older rural adults surviving a ten-year, two-wave investigation. Results of the study provided support for the hierarchical factor structure of well-being in cross-sectional analyses. This factor structure was varied across time, however.

Comparison of immunofluorescence and enzyme immunoassay for detection of measles-specific immunoglobulin M antibody.

During a measles outbreak, 283 serum specimens from 221 suspected cases of measles were tested by immunofluorescence and enzyme immunoassay for the presence of measles-specific immunoglobulin M (IgM) antibodies by using commercially available reagents. There was 97% agreement between the two assays; thus, the choice of the method for diagnostic testing is a matter of convenience and experience. In all 62 cases of measles from which a single blood sample was available, measles IgM-specific antibodies were detectable by both methods. Fifty percent of the 62 cases were positive within 3 days after onset of the rash. This increased to 91% 10 days after onset of the rash.

Cochlear implant.

Cochlear implantation to restore some of the hearing in the profound or totally cochlear deaf patient has been briefly presented. An approximate two year follow up has not shown any complications. The Nucleus 22 channel cochlear implant, as presently manufactured, is a very useful device to rehabilitate profoundly or totally cochlear deaf patients.

The relationship of intergenerational reciprocity of aid to the morale of older parents: equity and exchange theory comparisons.

Information concerning the relationship of intergenerational helping to older adult well-being is ambiguous. Intergenerational reciprocity was investigated using two competing theoretical perspectives, social exchange and equity propositions. Social exchange propositions predict a linear relationship between intergenerational aid and older parent morale, with higher morale positively related to giving or receiving more intergenerational help. Equity propositions predict that the intergenerational aid, morale relationship will be curvilinear, with higher older parent morale related to balanced exchanges of intergenerational aid. Neither theoretical perspective was supported by the data. Intergenerational aid was not useful in explaining variance in older parent morale regardless of the operational definition of intergenerational aid. These results provide support for earlier studies that conclude the amount of help exchanged within families does not affect the well-being of older family members.

Comparison of immunoblotting with other serological methods and virus isolation for the early detection of primary cytomegalovirus infection in allograft recipients.

Sequential specimens from nine allograft recipients were examined by using a variety of methods to detect primary cytomegalovirus (CMV) infection as rapidly as possible posttransplantation. Sera were examined for immunoglobulin G (IgG) and IgM antibodies by immunoblotting, enzyme immunoassay, and immunofluorescence and also by complement fixation, latex agglutination, and an immunofluorescence test for antibody to CMV early antigen. Urine and occasionally blood, tissue, and other specimens were centrifuged onto cell cultures to enhance CMV infectivity. Eight of the nine patients showed laboratory evidence of primary CMV infection, and CMV was isolated from seven of the eight: in no case was virus isolated before seroconversion had become evident. However, serological tests differed in their abilities to detect antibody response to CMV infection in different patients; while immunoblotting, latex agglutination, and enzyme immunoassay for IgG antibodies generally detected seroconversion before complement fixation, this was not invariably the case. At present, optimal laboratory detection of CMV infections in these patients can be achieved only by a combination of serological methods and virus isolation.

Right ventricular endomyocardial biopsy. Obtaining specimens via the internal jugular vein.

A right ventricular endomyocardial biopsy is a useful procedure for monitoring heart transplant patients or in diagnosing and treating patients with various cardiac and systemic diseases. When performed by an experienced cardiologist, there is little risk. The procedure, however, does require the nurse to perform the necessary patient preparation and monitoring along with standard nursing care to be successful.

Rapid detection of influenza virus infections in human fetal lung diploid cell cultures.

Haemadsorbing foci were found in human fetal lung (HFL) diploid cell cultures 12 h after inoculation with influenza viruses A and B. The size and number of the foci were maximal after 48 h of incubation, being limited by production of an unidentified inhibitor. By contrast, inoculation with parainfluenza virus type 3 led to haemadsorption which increased during 10 days of incubation. For the detection of influenza viruses A and B maximum sensitivity was achieved by changing the medium, the day before use to one that was serum free. The number of foci at 15.5 h post-infection and infectivity for primary African green monkey kidney (AGMK) cultures were similar. Virus infectivity and production of haemagglutinin in HFL cells were entirely cell-associated; they were not affected by treatment with trypsin. Nevertheless, influenza viruses A and B antigens were identified in the infected cells by means of immunofluorescence at 15.5 h and virus was recovered by passage of frozen and thawed cells in AGMK cultures. For rapid routine diagnosis of viral infections, the early haemadsorption test was shown to have the same sensitivity as immunofluorescence tests on specimens and virus detection by the shell-vial technique but was cheaper and simpler to perform.

The relation of climate and topography to gastro-intestinal nematode worm egg counts of Angora goats in the Eastern Cape.

Haemonchus, Trichostrongylus, Ostertagia and Nematodirus worm populations of Angora goats, based on differential egg counts, are considered in relation to climatological and topographical data. Egg counts indicated that the estimated worm populations in goats that experienced wet circumstances were higher than those exposed to dry conditions. Wetness was assessed by relating spring, summer, and early autumn rainfalls to ground slope. It is proposed, that tactical anthelmintic treatments of goats be based on the degree of wetness of the grazing or property.