Health-related quality of life in patients receiving reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation.

Reduced-intensity conditioning allogeneic HSCT (RIC) has less regimen-related morbidity and mortality than myeloablative allogeneic HSCT (MT) offering allogeneic transplantation to patients otherwise excluded. Whether these advantages improve health-related quality of life (HRQL) is unknown. We examined the HRQL effects of RIC and MT in patients with hematological diseases pre-transplant (baseline), days 0, 30, 100, 1 and 2 years following HSCT. HRQL was measured using the Short Form-36 Health Survey and the Functional Assessment of Cancer Therapy - General and BMT. Data were analyzed using mixed linear modeling adjusting for baseline HRQL differences. Patients (RIC=41, MT=35) were predominately male (67%), in remission/stable disease (65%) with an Eastern Cooperative Oncology Group status

Herbal medicines for the treatment of rheumatoid arthritis: a systematic review.

OBJECTIVE: With the growing interest in herbal therapies among persons with rheumatoid arthritis, there exists a need for investigation into their safety and efficacy. The purpose of this study was to conduct a systematic review to examine the evidence for the use of herbal medicines for RA based on randomized clinical trials (RCTs). METHODS: A computerized search of eight electronic databases and the bibliographies of identified articles resulted in 14 studies meeting the inclusion criteria. Two raters independently extracted data and rated the trials for quality. RESULTS: There is moderate support for gamma-linolenic acid (GLA), which is found in some herbal medicines, for reducing pain, tender joint count and stiffness. For other herbal medicines there was only a single RCT available, resulting in weak evidence. In general, herbal preparations were relatively safe to use. CONCLUSIONS: Given the number of herbal medicines promoted for RA, further research is needed to examine their efficacy, safety and potential drug interactions.

Rhodes Index of Nausea and Vomiting--Form 2 in pregnant women. A confirmatory factor analysis.

BACKGROUND: Despite widespread application of Rhodes Index of Nausea and Vomiting-Form 2 (INV2) in practice and research, empirical analyses have not been consistently performed to verify the a priori factors that guided the subclass construction of the symptoms. OBJECTIVES: To examine the dimensional structure of Rhodes INV in a sample of pregnant women. METHOD: Data were collected from 152 pregnant women who were experiencing some degree of nausea and vomiting during early pregnancy and analyzed using structural equation modeling techniques. Five competing measurement structures were tested and compared. The structure (model) that provided the closest fit to the data was selected and relationships (factor loadings) between the constructs and indicators were established. RESULTS: The model fitting the data the closest was a three-factor structure measuring nausea, vomiting, and retching as three separate, but correlated dimensions. The factor loadings were high (0.73-0.96) and significant (p < .001). The model treating nausea and vomiting as a one-factor concept as well as the model including two factors named symptom occurrence and symptom distress did not fit the data. CONCLUSION: Rhodes INV2 is a valid measurement tool if subscales are formed to reflect the multidimensional structure of nausea and vomiting in pregnancy.

Herbal medicines for the treatment of osteoarthritis: a systematic review.

OBJECTIVE: Limitations in the conventional medical management of osteoarthritis indicate a real need for safe and effective treatment of osteoarthritis patients. Herbal medicines may provide a solution to this problem. The aim of this article was to review systematically all randomized controlled trials on the effectiveness of herbal medicines in the treatment of osteoarthritis. METHODS: Computerized literature searches were carried out on five electronic databases. Trial data were extracted in a standardized, predefined manner and assessed independently. RESULTS: Twelve trials and two systematic reviews fulfilled the inclusion criteria. The authors found promising evidence for the effective use of some herbal preparations in the treatment of osteoarthritis. In addition, evidence suggesting that some herbal preparations reduce consumption of non-steroidal anti-inflammatory drugs was found. The reviewed herbal medicines appear relatively safe. CONCLUSIONS: Some herbal medicines may offer a much-needed alternative for patients with osteoarthritis.

Mental health services for youths in foster care and disabled youths.

OBJECTIVES: This study assessed whether mental health services for youths differ with respect to medical assistance aid category. METHODS: Computerized claims for 15,507 youths with Medicaid insurance in a populous county of a mid-Atlantic state were used to establish population-based prevalence estimates of mental disorders and psychotherapeutic treatments during 1996. RESULTS: An analysis of service claims revealed that the prevalence of mental disorders among youths enrolled in foster care (57%) was twice that of youths receiving Supplemental Security Income (SSI; 26%) and nearly 15 times that of other youths receiving other types of aid (4%). Rates of mental health service use were pronounced among foster care youths aged 6 to 14 years. Attention deficit/hyperactivity disorder, depression, and developmental disorders were the most prevalent disorders. Stimulants, antidepressants, and anticonvulsants were the most prevalent medications. CONCLUSIONS: Youths enrolled in foster care and youths receiving SSI use far more mental health services than do youths in other aid categories. Additional research should evaluate the complexity and outcomes of mental health services for youths in foster care.

Pain experiences of traumatically injured patients in a critical care setting.

BACKGROUND: Little is known about the acute pain experiences of traumatically injured critically ill patients. OBJECTIVES: To describe pain experiences of traumatically injured adults during the first 72 hours of hospitalization. METHODS: Thirty multiply injured adults at a level I trauma center participated in the study. Pain was measured by using the McGill Pain Questionnaire and a visual analog scale. Subjects completed pain measures while at rest in a supine recumbent position and after a turn onto the side. RESULTS: The typical subject was 37 years old, had 4 major blunt trauma injuries, and had received the equivalent of 55.9 mg of morphine during the 24 hours before data collection. Mean at-rest scores were 26.5 on the pain-rating index, 2 on the present pain intensity index, and 34.6 on the visual analog scale. Immediately after the turn, mean scores on the visual analog scale increased from 25 to 48.1 (P = .002). Other pain scores after the turn did not differ significantly from at-rest values. Subjects who turned had lower scores on the visual analog scale at rest (P = .02) and less anxiety (P = .02) than did those who refused to turn. Ninety-six percent reported pain in the injured areas, and 36% reported pain related to biomedical devices. No relationship was found among reported pain and demographic, treatment, or clinical variables. CONCLUSIONS: Additional research is needed on pain at rest and during commonly performed procedures and on improved methods for pain relief in traumatically injured critically ill patients.

An evaluation of interventions to decrease intimate partner violence to pregnant women.

Prevention of abuse to women is a national priority; however, research has focused on identification of abuse rather than evaluating interventions. To evaluate the differential effectiveness of three levels of intervention, Brief, Counseling, and Outreach, a longitudinal study with repeated evaluation interviews at 2-, 6-, 12-, and 18-months postdelivery was completed at two urban public health prenatal clinics. The participants were 329 pregnant, physically abused Hispanic women. Both physical abuse and women's use of community resources were measured. Repeated measures ANOVA showed that severity of abuse decreased significantly (p < 0.001) across time for all intervention groups. Violence scores at 2-months postdelivery were significantly lower for the Outreach group (p < 0.05) compared to the Counseling only group, but not significantly lower than the Brief intervention group. At 6-, 12-, and 18-month follow-up there were no statistically significant differences among the intervention groups. The use of lay outreach for abused pregnant women merits further research. Abuse screening by itself, however, may be the most effective intervention to prevent abuse to pregnant women.

Social support transactions between professional and nonprofessional women and their mothers.

A theoretical model predicting professional and nonprofessional women's perceptions of social support transactions with their mothers was tested. A sample of 210 Professional women and 165 nonprofessional women answered mailed questionnaires. LISREL VI was used to evaluate the quality of the measurement model and generate a revised model. Social support was greatest when employed women were professional, had positive filial responsibility attitudes, lived near their mothers, visited them frequently, and when mothers were not married. These findings provide a beginning theoretical model that can serve as a basis for nursing practice and research when working with intergenerational families.

Workplace access, negative proscriptions, job strain, and substance use in registered nurses.

BACKGROUND: Both occupational conditions and individual factors have been shown as contributors to the likelihood of substance use among health professionals. OBJECTIVES: To assess the use of Winick's (1974) model for explaining nurses' substance use, which asserts that groups with access to substances, freedom from negative proscriptions, and role strain have an increased likelihood of drug dependence. METHODS: Data were analyzed from the 3,600 working nurses participating in the Nurses Worklife and Health Study, a nationally representative survey of registered nurses in the United States. A structural equation model was tested fitting workplace access to substances (availability, frequency of administration, and knowledge), freedom from negative proscriptions (internal: religiosity; external: social network), and role strain (job demands and depressive symptoms) to the frequency of past year alcohol, marijuana/cocaine, and prescription-type drug use. RESULTS: Nurses were more likely to use substances when workplace access to substances increased (p < 0.001), with social networks containing more drug users, and when religiosity decreased (p < 0.001). Role strain (measured through job demands and depressive symptoms) also was related to substance use. Depressive symptoms were related directly and negatively to substance use (p < 0.01), whereas job demands were related indirectly to substance use through depressive symptoms. CONCLUSIONS: Winick's model has use in explaining nurses' substance use. Research and preventive initiatives should consider the multidimensional aspects of substance use in nurses.

Risk factors for nosocomial pneumonia in critically ill trauma patients.

Nosocomial pneumonia is the most common pulmonary complication in trauma patients and the leading cause of death in nosocomial infections. A comprehensive review of pneumonia studies is provided. The Centers for Disease Control's nosocomial pneumonia pathogenesis model is reviewed and was used to guide the selection of risk factors evaluated in this study. The purposes of this research were to identify underlying dimensions (factors) of variables that increase the risk of nosocomial pneumonia and to identify predictors of nosocomial pneumonia in critically ill trauma patients.

Weight change of infants, age birth to 12 months, born to abused women.

Abuse to pregnant women can affect maternal health and infant birthweight. To examine the rate of weight change among infants, ages birth to 12 months, born to women abused by the male intimate, an ethnically stratified cohort of 121 infants and their mothers were followed. Infants were weighed on a beam balance scale at birth, 6, and 12 months of age. At the same time, abused mothers were asked if the abuse had ended. Rate of change in infant weight was calculated for birth to 6 months and 6 months to 1 year. The rate of change in infant weight from birth to 6 months did not differ significantly based on whether or not the mother reported that the abuse had ended by 6 months or 12 months. However, the rate of change in infant weight from 6 to 12 months was significantly greater (p = .046) for those infants whose mothers reported the abuse had ended by 12 months and even greater (p = .019) if the mother reported that the abuse had ended by 6 months. When controlling for ethnicity and parity, abuse ending at 6 months was a significant (p = .029, r2 = .102) predictor of the rate of infant weight change from 6 to 12 months. To maximize infant growth and the health and wellbeing of mother and child, routine screening and intervention for abuse of women is recommended during child health visits.

Severity of abuse before and during pregnancy for African American, Hispanic, and Anglo women.

OBJECTIVE: To describe timing and severity of abuse before and during pregnancy for African American, Hispanic, and white Anglo American women. FINDINGS: Among 199 abused women, 18.1% of the women were abused during pregnancy but not the year before, 30.2% were abused the year before but not during pregnancy, and 51.8% were abused both the year before and during pregnancy. The timing of abuse did not vary by ethnicity. The three (ethnicity) by three (timing) factorial analysis of variance showed severity of abuse to vary by timing of abuse. Women reporting abuse both before and during pregnancy reported greater severity of abuse on each of the five measures than did women abused only before pregnancy or only during pregnancy. CONCLUSIONS: Over half (51.8%) of the women reported abuse before and during pregnancy with these women reporting greater severity of abuse on all five severity scores. Timing and severity of abuse did not vary by ethnic group. The majority of women abused during pregnancy were also abused prior to pregnancy, indicating the need for universal screening of all women during each health encounter.

Testing an intervention to prevent further abuse to pregnant women.

Although violence against women is recognized as a major public health problem, few interventions have been developed to reduce abuse. In this study, 132 pregnant women received three counseling sessions that were designed to reduce further abuse. A comparison group of 67 abused women were offered wallet-sized cards listing community resources for abuse. Women in both groups were followed at 6 months and 12 months post-delivery. Using repeated measures MANCOVA with entry scores as a covariate, we found significantly less violence reported by women in the intervention group than by women in the comparison group.

Women's responses to battering: a test of the model.

A volunteer community sample of 141 well-educated, economically heterogeneous, primarily African American (80%), urban battered women was used to test a model of women's responses to battering. The model, based on Orem's theory, was developed previously with an independent sample. The major independent variables were physical and nonphysical abuse, and self-care agency. The outcomes were physical and emotional health. Using structural equation modeling techniques, there was sufficient support for the model structure to conclude preliminary support for the overall model. There was both a direct effect of abuse on health, and an indirect effect mediated through self-care agency as a protective factor.

Use of counseling by abused pregnant Hispanic women.

The purpose of this study was to determine if there are characteristics of abused women that are associated with the women's use of the services of counseling to help end the abuse. The research design was a prospective, descriptive analysis of 216 abused pregnant Hispanic women receiving prenatal care in urban public health clinics. Women who were abused by their intimate male partner were offered unlimited access to the services of a bilingual English/Spanish-speaking counselor experienced in abuse whose office was located in the public health clinic. Baseline demographic characteristics, severity of abuse experienced by the women, and the women's previous use of community resources were assessed. Analyses were conducted to examine associations between baseline characteristics and the number of visits the abused women made to the counselor. The results of the study show that when an abused pregnant Hispanic woman had an average of two or more children, she was more likely to use the services of an abuse prevention counselor. The study also showed that the women who had used the police most during the previous 12 months made the fewest number of visits to the counselor. Prenatal care may provide a convenient and safe setting for low-income, ethnic minority women with numerous children to conveniently and safely access abuse prevention services. Research is needed on the effectiveness of incorporating abuse intervention services into nontraditional settings, such as neighborhood clinics.

Severity of abuse to pregnant women and associated gun access of the perpetrator.

To investigate the relationship between abuse to pregnant women and gun access by the abuser, an ethnically stratified cohort of 199 pregnant abused women (70 African-Americans, 63 non-Hispanic Anglo-American, and 66 Hispanic women were interviewed using: (1) The Index of Spouse Abuse, a measure of the severity of physical and nonphysical abuse; (2) The Danger Assessment Scale, a measure of potential danger of homicide; and (3) The Severity of Violence Against Women Scale, a measure of threats of violence and actual violence. There were no significant differences by ethnicity among the 41.2% of the abused women who reported that their male partner had access to a gun. Among these same women reporting gun access, 17% reported the abuser kept the gun on his body. Women reporting gun access by the abuser reported higher level of abuse on all scaled instruments (P = < 0.01). To protect women's safety and prevent further trauma and potential homicide, routine assessment for abuse and gun access is recommended. Additionally, policy initiatives to remove firearms from abuse perpetrators may reduce the severity of violence experienced by abused women.

Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity.

BACKGROUND: The coagulopathy noted in hypothermic trauma patients has been variously theorized to be caused by either enzyme inhibition, platelet alteration, or fibrinolytic processes, but no study has examined the possibility that all three processes may simultaneously contribute to coagulopathy, but are perhaps triggered at different levels of hypothermia. The purpose of this study was to determine whether, at clinically common levels of hypothermia (33.0-36.9 degrees C), there are specific temperature levels at which coagulopathic alterations are seen in each of these processes. METHODS: Of 232 consecutive adult trauma patients presenting to a Level I trauma center, 112 patients met the inclusion criteria of an Injury Severity Score of 9 or greater and time since injury of less than 2 hours. Of the included patients, 40 were normothermic and 72 were hypothermic (> or =37 degrees C, n = 40; 36.9-36 degrees C, n = 29; 35.9-35 degrees C, n = 20; 34.9-34 degrees C, n = 16; 33.9-33 degrees C, n = 7). Included patients were prospectively studied with thrombelastography adjusted to core body temperature. Additionally, PT, aPTT, platelets, CO2, hemoglobin, hematocrit, and Injury Severity Score were measured. RESULTS: Analysis by multivariate analysis of variance of the relationship between coagulation and temperature demonstrated that in hypothermic trauma patients, 34 degrees C was the critical point at which enzyme activity slowed significantly (p < 0.0001), and at which significant alteration in platelet activity was seen (p < 0.001). Fibrinolysis was not significantly affected at any of the measured temperatures (p > 0.25). CONCLUSIONS: Patients whose temperature was > or =34.0 degrees C actually demonstrated a significant hypercoagulability. Enzyme activity slowing and decreased platelet function individually contributed to hypothermic coagulopathy in patients with core temperatures below 34.0 degrees C. All the coagulation measures affected are part of the polymerization process of platelets and fibrin, and this process may be the mechanism by which the alteration in coagulation occurs.

Safety behaviors of abused women after an intervention during pregnancy.

OBJECTIVE: To evaluate an intervention protocol, administered during pregnancy, for increasing safety-seeking behaviors of abused women. DESIGN: Prospective, ethnically stratified cohort analysis. SETTING: Public prenatal clinics. PARTICIPANTS: Pregnant women reporting physical or sexual abuse in the year before or during the present pregnancy. One hundred thirty-two women met study criteria, received the intervention, and were followed for 1 year after the completion of the pregnancy. INTERVENTION: Three education, advocacy, and community referral sessions that included information on safety behaviors. MAIN OUTCOME MEASURE: Adoption of safety behaviors by abused women. Safety behaviors were measured before the intervention, twice during pregnancy, and at 2, 6, and 12 months after completion of the pregnancy. RESULTS: Repeated measures analysis of variance showed a significant increase in adoption of each safety behavior (p < .0001), with most behaviors showing a significant increase after the first intervention session. CONCLUSIONS: Pregnant women who were abused and were offered an intervention protocol report a significant increase in safety behavior adoption during and after pregnancy. Abuse during pregnancy is common. Identification of abuse and immediate clinical intervention that includes information about safety behaviors can result in safety behavior adoption that may prevent future abuse and increase the safety and well-being of women and infants.

PIP: This study evaluates an intervention protocol administered during pregnancy for encouraging safety-seeking behaviors of abused women. The participants were 132 pregnant women recruited from public prenatal clinics that reported physical or sexual abuse prior or during the present pregnancy. Data were collected from an assessment on pregnant women using the Abuse Screen and Safety Assessment. After completion of the Safety Assessment, the women received an intervention protocol. Each woman received the intervention three times during pregnancy: at entry into the study; and two additional times evenly spaced throughout pregnancy. In this group of 132 pregnant women who were abused, adoption of safety behaviors significantly increased after the first intervention session. Furthermore, the adoption of safety behavior occurred across all ethnic groups. Pregnant women, who were abused, were offered an intervention protocol report showing a significant increase in safety behavior adoption during and after pregnancy. Abuse during pregnancy is common and the identification of abuse and immediate clinical intervention that includes information about safety behaviors can result in safety behavior adoption that may prevent future abuse and increase the safety and well-being of women and infants.

Violent pornography and abuse of women: theory to practice.

To examine violent pornography use and associated violence against women, an ethnically stratified sample of 198 abused women were asked about their partners' use of pornographic materials, and if they had been asked or forced to look at, act out, or pose for pornographic scenes or pictures. Overall, 40.9% of the women reported the abuser used pornographic material, with the proportion significantly higher for Whites (58.7%), compared to Blacks (27.1%) or Hispanics (38.5%). When groups were formed according to the abuser's use of pornography and associated involvement of the woman, violence scores as measured on the Index of Spouse Abuse, Danger Assessment, and Severity of Violence Against Women scales were significantly higher (p = <.001) for women reporting the abuser requested or forced her to look at, act out, or pose for pornographic scenes. Severity of violence was not related simply to whether or not the abused used pornography. This analysis is a beginning step toward understanding how pornography influences woman abuse.

Symptoms of post-traumatic stress disorder in abused women in a primary care setting.

Abuse is a major source of trauma to women, and post-traumatic stress disorder (PTSD) results from exposure to extreme trauma. To describe the relationship between symptoms of PTSD and severity of abuse, an ethnically stratified cohort of 131 abused women in a primary care setting was interviewed. Symptoms of PTSD, both intrusion (i.e., trouble falling asleep, strong waves of feelings about the abuse) and avoidance (i.e., trying not to think or talk about the abuse, staying away from reminders of the abuse), were significantly (p < 0.01) correlated to severity of abuse, regardless of ethnicity. When asked about childhood physical or sexual abuse, women reporting physical abuse had significantly (p < 0.05) higher intrusion scores, whereas those reporting sexual abuse had significantly (p < 0.004) higher avoidance scores. Sixty-five percent of the women reported dreams, flashbacks, or terror attacks and had significantly (p < 0.001) higher mean results on both intrusion and avoidance. The need to offer abused women information about the connection between severity of abuse and symptoms of PTSD is discussed. We recommend that clinicians ask all abused women about dreams, flashbacks, or terror attacks to assess for further symptoms of PTSD.