Experiencing stigma as a nurse with mental illness.

WHAT IS KNOWN ON THE SUBJECT?: Stigma involves connecting individuals with a particular label to negative characteristics; this is based not on the stigmatized condition itself, but cultural reactions to it. Stigma exists towards nurses with mental illness. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper offers a first-person account of experiencing stigma as a nurse with a mental illness. This paper incorporates the existing literature to offer a broader cultural perspective on the experiences of a nurse with a mental illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses are likely to encounter a nurse with a mental illness at some point in their practice. Nurses' reactions towards colleagues with mental illness can have significant implications for those colleague(s)' wellbeing. Nurses with mental illness will have to navigate their person and professional journey while giving consideration to the attitudes of their nursing peers and leaders. ABSTRACT: Limited research has been done on the stigma faced by nurses with mental illness from their nursing peers. Mental illness is not generally considered acceptable within the context of nursing culture, so when nurses do experience mental illness, their experiences in a professional context may be influenced by stereotypes, particularly those relating to dangerousness. Using autoethnography as a research method, the author examines her own subjective experiences of stigma as a nurse with a mental illness, and draws upon existing literature on stigma, deviance and the phenomenon of mental illness in nurses to analyse broader cultural implications for nursing. Assessment of suitability to return to work arises throughout the narratives, and consideration is given to the way that risk assessment by nursing leaders is impacted by negative stereotypes that surround mental illness.

Association of cognitive domains with postural instability/gait disturbance in Parkinson's disease.

INTRODUCTION: Research suggests an association between global cognition and postural instability/gait disturbance (PIGD) in Parkinson disease (PD), but the relationship between specific cognitive domains and PIGD symptoms is not clear. This study examined the association of cognition (global and specific cognitive domains) with PIGD symptoms in a large, well-characterized sample of individuals with PD. METHODS: Cognitive function was measured with a detailed neuropsychological assessment, including global cognition, executive function, memory, visuospatial function, and language. PIGD symptoms were measured using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, Motor Examination subscale. Multiple linear regression analyses were performed to assess the relationship between cognition and PIGD symptoms with models adjusting for age, sex, education, enrollment site, disease duration, and motor symptom severity. RESULTS: The analysis included 783 participants, with mean (standard deviation) age of 67.3 (9.7) years and median (interquartile range) MDS-UPDRS Motor Subscale score of 26 (17, 35). Deficits in global cognition, executive function, memory, and phonemic fluency were associated with more severe PIGD symptoms. Deficits in executive function were associated with impairments in gait, freezing, and postural stability, while visuospatial impairments were associated only with more severe freezing, and poorer memory function was associated only with greater postural instability. DISCUSSION: While impairments in global cognition and aspects of executive functioning were associated with more severe PIGD symptoms, specific cognitive domains were differentially related to distinct PIGD components, suggesting the presence of multiple neural pathways contributing to associations between cognition and PIGD symptoms in persons with PD.

Exercise-induced metacarpophalangeal joint adaptation in the Thoroughbred racehorse.

Repetitive bone injury and development of stress fracture is a common problem in humans and animals. The Thoroughbred racehorse is a model in which adaptive failure and associated development of stress fracture is common. We performed a histologic study of the distal end of the third metacarpal bone in two groups of horses: young Thoroughbreds that were actively racing (n = 10) and a group of non-athletic horses (n = 8). The purpose of this study was to determine whether development of articular microcracks was associated with specific alterations to subchondral plate osteocytes. Morphometric measurements were made in five regions of the joint surface: lateral condyle, lateral condylar groove, sagittal ridge, medial condylar groove, and medial condyle. The following variables were quantified: hyaline cartilage width; calcified cartilage width; the number of tidemarks; microcrack density at the articular surface; blood vessel density entering articular cartilage; the presence of atypical bone matrix in the subchondral plate; bone volume fraction; and osteocyte density. Adaptation of articular cartilage was similar in both groups of horses. Vascularization of articular cartilage was increased in the group of non-athletic horses. Microcracks, which typically had an oblique orientation to the joint surface, were co-localized with blood vessels, and resorption spaces. Microcracking was increased in the condylar grooves of athletic horses compared with the other joint regions and was also increased compared with the condylar groove regions of non-athletic horses. Coalescence of microcracks also led to development of an intracortical articular condylar stress fracture in some joints and targeted remodeling of affected subchondral plate. The subchondral plate of the condyles in athletic horses was sclerotic, and contained atypically stained bone matrix with increased numbers of osteocytes with atypical morphology. However, osteocyte numbers were not significantly different between groups. We conclude that differences in site-specific microdamage accumulation and associated targeted remodeling between athletic and non-athletic horses are much greater than differences in subchondral osteocyte morphology. However, the presence of atypical subchondral bone matrix in athletic horses was associated with extensive osteocyte loss. Although osteocyte mechanotransduction is considered important for functional adaptation, in this model, adaptation is likely regulated by multiple mechanotransduction pathways.

Weight gain as a barrier to smoking cessation among military personnel.

PURPOSE: To assess the relationships between active-duty military status, military weight standards, concern about weight gain, and anticipated relapse after smoking cessation. DESIGN: Cross-sectional study. SETTING: Hospital-based tobacco cessation program. SUBJECTS: Two hundred fifty-two enrollees, of 253 eligible, to a tobacco cessation program in 1999 (135 men, 117 women; 43% on active duty in the military). MEASURES: Independent variables included gender, body mass index (weight/height2), and military status. Dependent variables included about weight gain with smoking cessation and anticipated relapse. RESULTS: In multivariate regression analyses that controlled for gender and body mass index, active-duty military status was associated with an elevated level of concern about weight gain (1.9-point increase on a 10-point scale; 95% confidence interval [CI], 1.0- to 2.8-point increase), as well as higher anticipated relapse (odds ratio [OR] = 3.6; 95% CI, 1.3 to 9.8). Among subjects who were close to or over the U.S. Air Force maximum allowable weight for height, the analogous OR for active-duty military status was 6.9 (p = .02). CONCLUSIONS: Occupational weight standards or expectations may pose additional barriers for individuals contemplating or attempting smoking cessation, as they do among active-duty military personnel. These barriers are likely to hinder efforts to decrease smoking prevalence in certain groups.

Smoking cessation and weight gain in the military.

Many studies of civilian populations have found a significant relationship between smoking cessation and weight gain. However, the effect of voluntary smoking cessation on weight for military personnel has not been studied. The present study evaluated 70 active duty military members (55 males and 15 females) who quit smoking after participating in an 8-week smoking cessation program. The results indicated that 88% of the participants gained weight and that the average weight gain was 6.4 lb (males, 5.5 lb; females, 9.8 lb). These results are particularly noteworthy because weight gain in military members may result in administrative actions for individuals exceeding weight standards. The authors recommend that military officials consider adopting a one-time temporary weight waiver for active duty military members who successfully quit smoking to help prevent any negative administrative consequences of post-cessation weight gain.

Dynamic markers of altered gait rhythm in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a disorder marked by loss of motoneurons. We hypothesized that subjects with ALS would have an altered gait rhythm, with an increase in both the magnitude of the stride-to-stride fluctuations and perturbations in the fluctuation dynamics. To test for this locomotor instability, we quantitatively compared the gait rhythm of subjects with ALS with that of normal controls and with that of subjects with Parkinson's disease (PD) and Huntington's disease (HD), pathologies of the basal ganglia. Subjects walked for 5 min at their usual pace wearing an ankle-worn recorder that enabled determination of the duration of each stride and of stride-to-stride fluctuations. We found that the gait of patients with ALS is less steady and more temporally disorganized compared with that of healthy controls. In addition, advanced ALS, HD, and PD were associated with certain common, as well as apparently distinct, features of altered stride dynamics. Thus stride-to-stride control of gait rhythm is apparently compromised with ALS. Moreover, a matrix of markers based on gait dynamics may be useful in characterizing certain pathologies of motor control and, possibly, in quantitatively monitoring disease progression and evaluating therapeutic interventions.

Behavioral treatment of insomnia: the Wilford Hall Insomnia Program.

Persistent insomnia is one of the most common patient complaints reported in primary care settings. This paper reviews the behavioral assessment and treatment approaches for persistent insomnia and reports the results of 42 consecutively treated patients in the Wilford Hall Insomnia Program. Patients were treated in a six-session, multiple-component behavioral group treatment program consisting of sleep restriction, stimulus control, sleep hygiene, relaxation training, and cognitive therapy. In addition, patients were seen for two individual treatment sessions in conjunction with the program and for two individual post-group treatment sessions to assess treatment progress. The results indicated that sleep onset latency was improved by 53%, wake after sleep onset was decreased by 40%, and sleep efficiency was improved by 22%. A detailed description of the behavioral treatment program for insomnia is provided as well as recommendations for practitioners working in primary care settings.

Relapse to smoking after basic military training in the U.S. Air Force.

This study examined predictors of smoking relapse in the year after the mandatory smoking ban during basic military training (BMT) in the U.S. Air Force. Participants were all smokers who completed BMT from August 1995 to August 1996 and relapsed to smoking in the subsequent year (N = 4,303). Results demonstrated that the vast majority of airmen (69.8%) returned to smoking within 1 month after BMT and that most (90%) were still in training status when they smoked their first cigarette after BMT. Relapsed smokers appeared more motivated to quit smoking at 1-year follow-up compared with when they were in BMT. Individuals making serious quit attempts after BMT were younger and had greater levels of physical activity, more confidence in quitting, and more favorable perceptions of the BMT ban than individuals not attempting to quit. Based on these findings, recommendations are discussed for improving abstinence rates after BMT.

Enhancement of cellular and humoral immunity in young broilers by the dietary supplementation of beta-hydroxy-beta-methylbutyrate.

As a dietary supplement, beta-Hydroxy-beta-Methylbutyrate (HMB), a catabolite of leucine, has been shown to reduce broiler mortality. In a series of experiments, male broilers (Experiments 1 and 2, n = 576) were grown for 21 days on diets that contained HMB at 0, 0.01. 0.05, and 0.10% of diet. In Experiment 3 (n = 240), chicks were fed diets containing 0, 0.05, 0.075, and 0.10% HMB. HMB dietary supplementation did not significantly affect broiler weight gain in any experiment. However, a trend toward increased mean broiler weight gain per bird was observed in Experiments 1 and 3 when HMB was consumed at 0.10% of the diet. Mean feed to gain ratio was not affected by the inclusion of HMB in broiler diets. In Experiment 3, HMB supplemented diets did not affect bursa of Fabricius, thymus, and spleen weights at 21 days of age. Cutaneous basophilic hypersensitivity response against pokeweek mitogen was higher (P < or = 0.05) at 48 and 72 hours post-injection in chicks on 0.05% dietary HMB (Experiment 1). In Experiment 2, this increase occurred 24 hours post-injection in chicks fed HMB at 0.01% of the diet. On the contrary, the T-cell mediated response against PHA-P mitogen was comparable between all dietary treatments in multiple experiments. Macrophage function profiles were determined at 21 days of age. All chicks in experiments 1 and 2 on HMB supplemented diets showed an increase in the recruitment of Sephadex-G50-elicited abdominal exudate cells (AEC). A 2-fold increase in AEC numbers occurred at the 0.10% HMB level (Experiment 1, P < or = 0.05). Although HMB supplementation did not significantly affect the phagocytic potential of the abdominal macrophages, nitrite levels in the macrophage culture supernatants were higher in 0.01% and 0.05% treatment groups as compared to the controls (Experiment 2, P < or = 0.04; Experiment 3, P < or = 0.05). HMB supplementation did not alter the bird's ability to clear Escherichiacoli or Salmonella arizona from the bloodstream. Beginning 7 days post-hatch, chicks were injected i.v. with a 7% sheep red blood cells suspension. Serum samples were collected to determine the primary and secondary antibody response. Chicks receiving the 0.1% HMB diet in Experiments 1 and 2 exhibited increased IgG and total anti-sheep red blood cell (SRBC) antibody levels during the primary response. During the secondary response, birds consuming the 0.10% HMB diet had elevated IgM levels as well as increased total anti-SRBC levels over the controls in Experiments 1 and 3. These studies show that HMB supplementation improves several immunological functions in young broilers, and such improvement may result in decreased mortality.

Evaluation of viability of excised rat intestinal segments in the Ussing chamber: investigation of morphology, electrical parameters, and permeability characteristics.

PURPOSE: To clarify relations between alterations in electrical and permeability data with time and to elaborate accompanying structural changes of intestinal segments in Ussing chamber experiments. METHODS: Excised intestinal segments from the rat were studied in a modified Ussing chamber. Experiments were run up to 180 minutes during which the electrical parameters, PD, SCC, and R, were measured and the permeability coefficients (Papp) of mannitol and propranolol were determined. Each segment was observed under the light microscope for morphological evaluation. RESULTS: PD and SCC values showed a decrease for most segments while the R values remained steady throughout the experiment. The Papp for propranolol increased aborally to the small intestine. For mannitol, the reversed was observed. In some cases, there was a time-dependent change in permeability for these marker molecules. The main morphological changes observed were a decreased nucleo-apical distance, decreased villi amplification factor, initial edema, cell sloughing, and epithelial restitution. CONCLUSIONS: The time-dependent changes in permeability coefficients of mannitol and propranolol are suggested to be related to changes in electrical parameters and morphological alterations. Presented data illustrates the importance of information regarding time-dependent structural changes for correct interpretation of permeability data.

In vitro exposure with beta-hydroxy-beta-methylbutyrate enhances chicken macrophage growth and function.

Beta-hydroxy-beta-methylbutyrate (HMB), a leucine catabolite, has been shown to decrease broiler mortality. One possible target of HMB action may be the cells of the immune system. Macrophages from a chicken macrophage cell line, MQ-NCSU, were exposed to 0, 10, 20, 40, 80, and 100 microg of HMB per 5 x l0(4) cells in a 96-well culture plate. After 24 h of exposure, macrophage proliferation was quantitated by an MTT bioassay. In duplicate experiments, HMB stimulated growth over control (p < or = 0.05) at a wide range of doses. Macrophages were exposed to 20 and 80 microg of HMB and the culture supernatant fractions tested for the presence of nitrite. HMB exposure (20 microg) increased nitrite production by 44.1% over the controls (Experiment 1, p< or =0.035). To determine the phagocytic potential of macrophages after HMB exposure, MQ-NCSU cell line and Sephadex-G50-elicited abdominal macrophages were incubated with fluorescent latex beads (1:40, macrophage to beads ratio) for I h and then analyzed by flow cytometry. When exposed to 40 microg HMB, the phagocytic potential of MQ-NCSU macrophages was significantly higher (31.7%) than that of the controls (p < or = 0.0006). Sephadex-elicited macrophages exhibited 14.4% increased phagocytosis over controls when treated with 80 microg HMB (p < or = 0.0016). When MQ-NCSU macrophages were exposed to HMB, Fc-receptor expression was significantly elevated over the controls (p < or = 0.0001). These data demonstrate that HMB exposure induces proliferation of macrophages in culture as well as enhances macrophage effector functions, such as nitrite production and phagocytosis. The findings of these studies imply that HMB can be used as a possible dietary immunomodulator.

Bulimic weight-loss behaviors in military versus civilian weight-management programs.

This descriptive study evaluated the presence of bulimic weight-loss behaviors in individuals enrolled in: (1) a military weight-management program (N = 51); (2) a civilian weight-management program (N = 53); and (3) a comparison (military normal-weight) group (N = 51). A modified version of the Stanford Eating Disorders Questionnaire was administered to all subjects. The results indicated that the military weight-management program group reported that they engaged in bulimic weight-loss behaviors two to five times more often than the comparison group, and that they engaged in vomiting, strenuous exercise, or use of sauna/steam room four times as often as the civilian weight-management program group. The results suggest that bulimic weight-loss behaviors may develop in individuals who feel extreme pressure to lose weight.

Is weight gain after smoking cessation inevitable?

Weight gain after smoking cessation was studied in a naturalistic setting where (1) all smokers quit and (b) risk factors for postcessation weight gain were modified. Participants were 332 military recruits (227 men, 105 women), 86 of whom were smokers who quit during 6 weeks of basic training. Results showed no significant weight changes for smokers who quit. Pretest smoking rates and feat of weight gain were unrelated to changes in weight. Results suggest that an intensive program that limits access to alcohol and foods that are high in fat and that increases physical activity can attenuate weight gain after smoking cessation.

Site specificity of pain and tension in tension-type headaches.

Previous studies have not found a significant correlation between location of pain and electromyogram levels in chronic headache patients. However, these studies only examined a limited number of muscle groups and did not assess subjective tension levels. The present study evaluated a group of tension-type (n = 43) and migraine and tension-type (n = 30) headache patients. Measures were obtained at five muscle sites (frontalis, temporalis, masseter, splenius capitis, and trapezius) for patient ratings of headache pain, patient ratings of muscle tension, and electromyogram recording cross-sectionally. Neither subjective pain nor tension ratings were found to be significantly related to electromyogram levels. The site-specificity relationship between chronic headache pain, subjective report of muscular tension, and electromyogram levels remains unclear.

Behavioral and pharmacological treatments for tic and habit disorders: a review.

Children with tic and habit disorders are often seen by pediatricians, psychologists, or psychiatrists for evaluation and treatment. Current knowledge of the treatment-outcome research in these areas can serve as an important guide in the evaluation and treatment planning process. This article reviews the behavior therapy and pharmacological treatment of motor and vocal tic disorders, self-destructive oral habits, trichotillomania (hair pulling), onychophagia (nail biting), and thumb sucking. The research evidence indicates that all of these disorders can be effectively treated with behavioral or pharmacological approaches.

Habit reversal treatment of temporomandibular disorders: a pilot investigation.

This study evaluated the use of behavior therapy to reduce teeth clenching and grinding as a treatment for temporomandibular disorders (TMD). Habit reversal was used to treat three adults with TMD using a multiple baseline across subjects design. The results indicated significant improvement for two of the three subjects including decreased self-reported pain, decreased pain upon muscle palpation, and increased maximum mandibular opening. However, temporomandibular joint sounds were increased. Habit reversal appears to be more effective in reducing the myofascial pain symptoms of TMD than in improving temporomandibular joint functioning.

Comparison of two scales in the assessment of muscle and joint palpation tenderness in chronic temporomandibular disorders.

Following the guidelines of the Craniomandibular Index, 23 chronic patients had 42 muscle and temporomandibular joint sites palpated. Two- and four-point scales were generated in response to the patient's reactions. After 6 weeks of treatment, patients measured with the 2-point scale showed 6.39% improvement in muscle tenderness and patients measured with the 4-point scale showed a 14.99% improvement. These changes were significantly different. Correlation between scales was r = .88 originally and increased to r = .91 after 6 weeks. Results showed that the 4-point scale is significantly more able to detect clinical changes in muscle and joint tenderness than is the 2-point scale.

An evaluation of behavioral treatments for Tourette syndrome.

The present study evaluated the effectiveness of self-monitoring, relaxation training and habit reversal in the treatment of 6 Tourette Syndrome (TS) subjects with multiple motor and vocal tics. A counterbalanced design was employed and tic frequencies were measured in the clinic setting using videotapes taken through a one-way mirror. Tics were reduced by an average of 55% with habit reversal, 44% with self-monitoring, and 32% with relaxation training and each behavioral procedure was the most effective treatment for at least one subject. All three treatment approaches may have some utility in the behavioral treatment of TS.