Nocturnal problems in postpolio syndrome: sleep apnea symptoms and nocturia.

Nocturia, generally accepted as an inevitable consequence of aging, is also a symptom of a potentially lethal condition--obstructive sleep apnea (OSA). The descriptive study reported in this article examined nocturia and sleep-related breathing problems in persons with postpolio syndrome (PPS) and tested the Sleep Disordered Breathing--Nocturia Model. This model describes the cascade of events that results in polyuria in persons with sleep-related breathing disorders. Data were analyzed with descriptive and inferential statistics. A 34-item questionnaire was published in the newsletter of a national polio support group, and the 584 respondents constituted a convenience sample. The results showed statistically significant associations between OSA symptoms, nocturia, poor sleep quality, daytime sleepiness, lower urinary tract symptoms, naps, and decreased self-rated health. Study limitations were the use of a convenience sample and possible self-selection of persons with more severe sleep and bladder problems. The results support the model and document how nocturia and sleep disturbances negatively impact persons with PPS.

Sleep apnea symptoms, nocturia, and diabetes in African-American community dwelling older adults.

The primary aim of this exploratory study was to examine the association between obstructive sleep apnea (OSA) symptoms, nocturia and diabetes in African-American community-dwelling older adults. A pencil and paper survey was used to collect symptoms of OSA, nocturia, excessive daytime sleepiness (EDS), lower urinary tract symptoms (LUT), and self-rated health. The convenience sample of community dwelling African-Americans (n = 87) included a majority of women (61%) and obese persons (60% with BMI > 30). The mean age was 64 years (range 50-91), and 40% were self reported Type 2 diabetics. Diabetics had significantly more OSA symptoms, more nocturia, and decreased self-rated health. Results of a stepwise logistic regression showed that persons with diabetes and those who reported EDS experienced significant three to four-fold risks for OSA. Similarly, diabetics, women, persons with LUT symptoms and those reporting EDS, had significant three to six-fold risks for nocturia > or = 2/night.

Sleep-disordered breathing as a mechanism for nocturia: preliminary findings.

Nocturia is commonly associated with prostate or bladder problems but is also an important symptom of obstructive sleep apnea, a potentially lethal condition. The primary purpose of this study was to test the relationship between symptoms of sleep-disordered breathing and increased nocturnal urine production as described by the Sleep-Disordered Breathing--Nocturia Model. The purpose of the first phase of this three-phase study was to survey community-dwelling older adults (> 55 years) about nocturia and sleep-disturbance symptoms. A random sample of 1,000 older adults, balanced by ethnicity and gender, were surveyed via a mailed questionnaire. The brief questionnaire included characterizing poor sleep quality, obstructive sleep apnea symptoms, nocturia, lower urinary tract symptoms, naps, and self-rated health. The return rate was low (18%, n = 176), but respondents were equally represented by gender and ethnicity across the targeted age groups. Half of the respondents (n = 87) reported > or = 2 voids per night, two-thirds of whom reported nocturia as bothersome. The data showed that African-American women had significant associations between episodes of nocturia and symptoms of obstructive sleep apnea, poor sleep quality, naps, and lower urinary tract symptoms, thus failing to support the notion that nocturia or sleep-disordered breathing are prostate or gender related. As expected, subjects (n = 80) who volunteered for the later phases of the study, had significantly more problems. These preliminary data suggest that the relationship between obstructive sleep apnea and nocturia is important because older adults are at higher risk of injury due to falls that may occur while attempting to toilet in the dark. Also, older adults may also be at higher risk of receiving inappropriate urologic treatment if they are not screened for sleep disorders when reporting nocturia along with symptoms of excessive daytime sleepiness and sleep-disordered breathing. Phases II and III of the parent study will include a detailed examination of hormonal, biochemical, and physical variables to further test the proposed Sleep-Disordered Breathing--Nocturia Model.

Health promotion behaviors of Jordanian women.

Many developing countries are undergoing industrialization and modernization, which has produced both positive and negative implications for health. This study was designed to adapt a well-known health measure to an Arab-Muslim population and to derive health promotion data for primary health care program planning for women in Jordan. A convenience sample of 512 literate females in Jordan was recruited from community settings such as secondary schools (teachers), primary health care centers (nursing staff and patients), universities (faculty and staff), colleges, and office worksites using an Arabic translated version of the Health Promoting Lifestyle Profile (HPLP) instrument. Subjects scored highest on self-actualization, interpersonal support, and nutrition but scored lower on the exercise and health responsibility domains. Unmarried women, however, scored higher on exercise and stress management. These findings support the development of educational efforts to increase women's awareness of relationships between lifestyle and health for both themselves and for their families.

PIP: Many developing countries are undergoing industrialization and modernization, which have produced both positive and negative implications for health. This study was conducted to describe relevant health promotion lifestyle behaviors among Jordanian women and to adapt a well-known health behavior instrument for use among Arab-Muslim populations. A convenience sample of 512 literate females in Jordan was recruited from community settings such as secondary schools (teachers), primary health care centers (nursing staff and patients), universities (faculty and staff), colleges, and office work sites. Using the Arabic translated version of the Health Promoting Lifestyle Profile, the researchers collected information from the convenience sample. Results showed that in general, Jordanian women manifested intermediate levels of health promotion behaviors in the areas of self-actualization, nutrition, interpersonal support, and stress management, while they demonstrated much lower levels of health responsibility and exercise except for the unmarried women. These findings support the development of educational efforts to increase women's awareness of the relationships between lifestyle and healthy behaviors.

Views of health promotion among primary health care nurses and midwives in Jordan.

The purpose of this study was to explore the attitudes of Jordanian nurses and midwives working in primary care settings regarding health promotion. Views of health promotion were examined using a descriptive survey design to measure nurses' perceptions of constraints, responsibilities for health promotion, and client's response to health education. All nurses and midwives (n = 104) working in the Irbid Governorate primary health care (PHC) and maternal and child health care (MCH) centers were surveyed and 95% responded. The data revealed that respondents acknowledged their responsibility to provide health activities and that nurses believed that they were better suited than physicians to do so. Fifty percent of respondents did not believe that lack of time was a barrier to carry out health promotion effectively. However, more midwives than nurses were pessimistic about patient teaching, patient acceptance, and the ability of the provider to make a difference in the patient's health behaviors.

Symptoms of urinary incontinence among older community-dwelling men.

The purpose of this study was to explore the problem of urinary incontinence among elderly men living in the community. Descriptive data from a mailed, 53-item survey were collected and analyzed. The subjects were a convenience sample of 2800 older community-dwelling men enrolled in a hospital-based senior citizens' group in the southwest United States. The 53-item, self-administered survey was designed with a large typeface and a reading level of 3 years of schooling. In pretesting, the instrument required approximately 10 minutes to complete. Within the 2-month response period, 1490 completed surveys were returned for a total response rate of 53%. A subsample of 434 respondents (29%) reported uncontrolled urine leakage of any amount during the month before the survey. Most of these elders reported mild symptoms (84%) or symptoms that had persisted longer than 1 month but less than 2 years (48%). Consistent with the mildness of symptoms reported, the most frequently reported wetness management products were household commodities, such as toilet tissue and paper towels. Only one third of subjects with urinary incontinence symptoms had discussed these symptoms with a physician. Of those who did, almost half received some type of treatment. Incontinence was found to be statistically associated with age, prostate surgery, diuretic use, difficulty in starting urination, and voiding small amounts. In most cases, however, incontinence demonstrated a limited statistical relationship to these variables commonly associated with incontinence. In contrast, caffeine use, a history of prostate problems, and the sensation of incomplete bladder emptying were statistically associated with continence. The prevalence of urinary incontinence among elderly community-dwelling men is significant, although most asserted that their problems with urine loss are mild. In addition to urinary incontinence, many continent and incontinent elderly men have a wide range of urinary dysfunction symptoms.

Psychosocial issues in geriatric urology: problems in treatment and treatment seeking.

Psychological and social issues are important in geriatric urology because they affect not only the patient's ability and willingness to seek out therapy, but also their ability to benefit from it. Many older adults with problems of bladder control, such as frequency, urgency, nocturia, and incontinence are deterred from seeking treatment by factors such as social disapproval and belief that bladder symptoms are normal or untreatable. Many older adults who present for treatment experience limitations of mental status or functional ability that merit attention because they can interfere with learning, motivation, and cooperation needed for successful treatment. Strategies are described that help to address these psychosocial issues and needs in older patients.

Urinary incontinence among primiparous women.

OBJECTIVE: The purpose of this study was to explore the symptoms of urinary incontinence among primiparous women. METHODS: This descriptive study used a paper and pencil mail survey. A sample of 300 primigravida mothers (aged 16 to 45 years; 10 weeks to 8 months postpartum) was garnered from a university-affiliated city-county hospital. RESULTS: Most respondents (53%, n = 65/122) reported urinary incontinence (UI) symptoms sometime before, during, or after pregnancy. Few respondents (6.2%, n = 4) had UI symptoms continuously across all time periods surveyed. Age did not contribute to UI when a comparison was made among mothers who were very young (aged 16 to 19 years), young (aged 20 to 29 years), and mature (aged 30 to 36 years). None of the respondents with persistent or current UI had reported the symptoms to a health care provider. Of those who had reported their symptoms (n = 11), only four mothers received any recommendations for treatment. CONCLUSIONS: However common UI may be during pregnancy, it is commonly overlooked as a problem amenable to simple and effective behavioral treatments. This study shows that UI is equally problematic for very young mothers and more mature mothers. Additional studies are indicated among very young mothers to document factors related to prevalence and incidence.

Fractures of the acetabulum: imaging, classification, and understanding.

For the patient with a traumatized acetabulum, accurate radiographic diagnosis and classification are the cornerstone of effective clinical care. The classification system of Judet and Letournel has led to improved management of such injuries. However, trauma-related acetabular fractures are often complex, with multiple fragments and secondary fracture lines. Furthermore, the Judet and Letournel system is complicated and easily misunderstood, reflecting the nature of the anatomy itself. Computed tomography (CT) provides information regarding the extent of the fracture and is complementary to radiography for ascertaining the spatial arrangement of fracture fragments. Three-dimensional (3D) reconstruction of CT data can be helpful in understanding the complex fracture patterns. These are divided into two main types: elementary fractures, which consist of injuries to a single structural component, and associated fractures, which are combinations of the elementary types. Three-dimensional CT is especially helpful in gaining perspective on the fracture orientation. Although questions remain as to its clinical application, 3D CT is a useful teaching tool for demonstrating the different types of acetabular fractures.

Three-dimensional quantitation of pediatric tumor bulk.

In pediatric oncology, therapeutic decisions are made based on tumor response to chemotherapeutic agents. Sequential measurement of tumor bulk and its percent change on therapy must be accurately assessed. Will 3-dimensional (3-D) volumetric determination improve our ability to assess tumor response to therapy? Forty-five CT scans of pediatric patients with unresectable thoracic or abdominal neoplasia were assessed for tumor bulk by the standard "2-dimensional (2-D)" volume formula (cross-sectional area x length) and by 3-D volumetric analysis. Thirty-two examinations were performed in follow-up, and percent change in tumor size was calculated. The 2-D volume calculation overestimated tumor volume by more than 50% on all but two examinations when the 2-D volume was compared with the 3-D volume. In 28% of follow-up examinations, the 2-D calculation of percent change differed by more than 10% from the 3-D volume. Fifteen percent differed by over 25%. This changed the response category of one patient from "no response" to "partial response". 3-D volumetric analysis, easily performed by a trained technologist, will give more accurate assessment of the actual tumor bulk and its subsequent changes in size in response to therapy.

Women in white.

The author uses an allegory based on personal experience to explore assumptions about our identity as nurses and our perceptions of patients.

Facilitating research utilization through collaboration.

The rhetorical gap between clinical practice and academia was tested by the development of a special program grant to facilitate use of research by staff nurses. The grant capitalized on an established collaborative relationship between a university school of nursing and a community hospital. The merger of education and practice demonstrated the principles of interinstitutional collaboration in action. Resources of the grant included a doctorally-prepared nurse and a clinical librarian to provide research utilization classes for staff nurses, and an academic credit course to address reality-based practice problems for nurse managers. The model developed for this effort is described and critical behavioral aspects of research utilization for practicing nurses and academic nurses are outlined.

How to provide around-the-clock CPR certification without losing any sleep.

Teaching and reviewing cardiopulmonary resuscitation (CPR) to employees is an important part of the role and responsibilities of hospital nurse educators. The new teaching technologies of computer-assisted instruction and interactive video have been merged into a teaching/learning system that was tested by a rural federal hospital. Over a 2-month period, more than one third of the hospital's staff members were certified in CPR by the standards of the American Heart Association with the learning system. Ease of operation, employee enthusiasm, and easy access to the equipment were identified as important factors that contributed to the successful implementation of this innovative CPR training/review program. Additional evaluation of the system confirmed that the system was efficient, cost effective, and time-saving.