Spiritual perception, attitudes about spiritual care, and spiritual care practices among nurse practitioners.

The purpose of the nonexperimental study was to examine the relationships among spiritual perception, attitudes about spiritual care, and spiritual care practices in nurse practitioners. Attitudes about providing spiritual care and spiritual care practices have been studied among nurse generalists, but little research has been conducted on nurses in advanced practice. All nurse practitioners registered by the state of Indiana were sent Reed's Spiritual Perspective Scale (SPS) and a modified version of the Nurses' Spiritual Care Perspectives Scale developed by Taylor, Highfield, and Amenta. Pearson correlation techniques were used to test for significant relationships. Statistically positive relationships were between perception of personal spirituality and 9 of the 12 spiritual care practices. Eight of the 13 items describing attitude toward providing spiritual care were statistically significant with the SPS. Implications of the findings are discussed.

Family intervention after stroke: does counseling or education help?

Two interventions for improving stroke caregiver knowledge, stabilizing family function, promoting patient adjustment, and enlisting the use of social resources after stroke were compared with routine medical and nursing care of stroke patients (n = 61) at a 440-bed Veterans Administration Medical Center. The education intervention (n = 64) consisted of classroom instruction for caregivers about basic stroke care principles. The counseling condition (n = 63) consisted of education plus seven follow-up problem-solving sessions with a social worker (for the caregiver). Six months and 1 year after the stroke, both interventions significantly improved caregiver knowledge and stabilized some aspects of family function better than routine care. Counseling was consistently more effective than education alone and resulted in better patient adjustment at 1 year. Neither intervention influenced the use of social resources.

The urban poor: an appropriate population for breastfeeding promotion programs.

Breastfeeding has won universal endorsement as a major contributor to child survival. The proliferation of breastfeeding promotion programs demonstrates the importance health professionals and funding agencies place on improving the incidence and duration of breastfeeding. An effective, cost-efficient breastfeeding promotion program should be directed at those who will receive the greatest health benefit from such an intervention, i.e., the group who 1) would experience the greatest threat to health by decreasing its breastfeeding practice, and 2) is at greatest risk of changing its breastfeeding habits. Since it is the urban poor primarily who satisfy both of these criteria breastfeeding promotion strategies should focus on them.

Prestroke family interaction as a predictor of stroke outcome.

The Family of Assessment Device and clinical data for 60 stroke patients were used to predict outcome at six months and one year poststroke. Ratings of behavior control and affective responsiveness of the family predicted number of days of rehospitalization during the study. Problem solving scores, family communication skills, and patient self-care ability predicted family-rated patient adjustment. Family function was a better predictor of hospital stay than baseline ratings of typical predictors of stroke outcome. Family function represents an area for potential stroke intervention that may have more relevance to efficient health care delivery and the clinical status of stroke patients than has previously been noted.

Family interaction and treatment adherence after stroke.

Caregivers of 60 stroke patients were assessed five months after patient discharge from a stroke care unit to determine the relationship between family function and poststroke treatment adherence. Areas of family interaction which were significantly related to ratings of treatment adherence included problem solving, communication, and affective involvement. Better functioning families were consistently high on signs of treatment adherence. Findings suggest that families with specific dysfunction may not be as capable of helping patients comply with rehabilitation efforts as families who function more effectively. Thorough family assessment to identify which areas of family interaction are most problematic in relation to adherence issues is recommended.

Alzheimer's disease: choline acetyltransferase activity in brain tissue from clinical and pathological subgroups.

Choline acetyltransferase activity was measured postmortem in five brain regions to determine if such activity provided biochemical support for clinical and pathological subgrouping of Alzheimer's disease. Seven patients with Alzheimer's disease were divided into groups based on age at onset, severity of neuropathological changes, history of myoclonus, family history of dementia, cerebellar amyloid plaques, and congophilic angiopathy. Thirty-two age-matched normal control subjects and 17 neurological control patients with Huntington's disease were also studied. Patients with early-onset and late-onset Alzheimer's disease did not differ in the clinical duration of their disease. Choline acetyltransferase activity was significantly lower in patients with early-onset Alzheimer's disease than in age-matched control subjects in frontal cortex, temporal cortex, hippocampus, and cerebellum. In contrast, choline acetyltransferase activity in patients with late-onset Alzheimer's disease was significantly lower than in age-matched control subjects only in hippocampus. There was a tendency for choline acetyltransferase activity to be lower in cortex from patients with early-onset Alzheimer's disease compared with cortex from the late-onset group, and this difference was significant in temporal cortex. Choline acetyltransferase activity was also measured in the substantia innominata from 9 patients with Alzheimer's disease and 5 age-matched control subjects. Subjects with early-onset Alzheimer's disease had significantly lower choline acetyltransferase activity in substantia innominata than did control subjects. Patients with Alzheimer's disease and a history of myoclonus had significantly lower choline acetyltransferase activity than did affected patients without myoclonus. Multivariate regression analysis showed myoclonus to be the single best predictor of low brain choline acetyltransferase activity. These results provide further evidence for clinical, pathological, and biochemical heterogeneity in Alzheimer's disease.

Genetic control of developmental patterns of cerebral enzyme activities: further differences between C3H and ICR strains of mice.

We have investigated developmental changes in activity for five enzymes associated with different cerebral metabolic systems in two separate strains of mice. The enzymes studied were acid beta-galactosidase, arylsulfatase A, cerebroside beta-galactosidase, cerebroside sulfotransferase, and glutamate decarboxylase. The two strains of mice were C3H/SWV and ICR/SWV. We confirm the experiments of Meisler, Paigen, and colleagues showing higher acid beta-galactosidase activity throughout development in C3H mice. In addition we have demonstrated higher arylsulfatase A activity throughout development in C3H mice. The shape of the developmental curve for arylsulfatase A activity in brain in the two strains was similar. There were no differences in developmental changes of activity between the two strains for the other three enzymes studied.

Developmental dissociation of myelin synthesis and "myelin-associated" enzyme activities in the shiverer mouse.

Developmental changes in three enzymes associated with myelin lipids were studied in the shiverer mouse, a murine mutant showing a severe deficiency of CNS myelin. Age-related changes in cerebroside sulfotransferase (measured in brain) and arylsulfatase A and cerebroside B-galactosidase (measured in brain and liver) were the same for shiverer and control mice. The shiverer mouse, therefore, demonstrates a dissociation between the genetic mechanisms regulating myelination in the CNS and developmental changes in enzyme activities thought to be closely related to the synthesis of myelin. In addition, we found no defect in the shiverer mouse in the incorporation of glycine-labeled basic protein into CNS myelin, indicating an important metabolic difference between the morphologically similar shiverer and quaking mutants.