HIV-related Pneumocystis carinii pneumonia in older patients hospitalized in the early HAART era.

OBJECTIVE: To determine whether older age continues to influence patterns of care and in-hospital mortality for hospitalized persons with HIV-related Pneumocystis carinii pneumonia (PCP), as determined in our prior study from the 1980s. DESIGN: Retrospective chart review. PATIENTS/SETTING: Patients (1,861) with HIV-related PCP at 78 hospitals in 8 cities from 1995 to 1997. MEASUREMENTS: Medical record notation of possible HIV infection; alveolar-arterial oxygen gradient; CD4 lymphocyte count; presence or absence of wasting; timely use of anti-PCP medications; in-hospital mortality. MAIN RESULTS: Compared to younger patients, patients > or =50 years of age were less likely to have HIV mentioned in their progress notes (70% vs 82%, P <.001), have mild or moderately severe PCP cases at admission (89% vs 96%, P <.002), receive anti-PCP medications within the first 2 days of hospitalization (86% vs 93%, P <.002), and survive hospitalization (82% vs 90%, P <.003). However, age was not a significant predictor of mortality after adjustment for severity of PCP and timeliness of therapy. CONCLUSIONS: While inpatient PCP mortality has improved by 50% in the past decade, 2-fold age-related mortality differences persist. As in the 1980s, these differences are associated with lower rates of recognition of HIV, increased severity of illness at admission, and delays in initiation of PCP-specific treatments among older individuals--factors suggestive of delayed recognition of HIV infection, pneumonia, and PCP, respectively. Continued vigilance for the possibility of HIV and HIV-related PCP among persons > or =50 years of age who present with new pulmonary symptoms should be encouraged.

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.

Prevalence and correlates of obesity in preschool children.

Obesity, a common nutritional disorder in childhood, is a complex problem that is poorly understood. The purpose of this study was to identify the prevalence of obesity in preschool children, and to examine the relationships between obesity and gender, race, socioeconomic status, and health problems. Data were collected from 309 charts of children enrolled in a Head Start program. Ninety-nine (32%) of the children were obese. Obese children had significantly higher blood pressure readings than those who were not obese. This study represents a beginning effort to learn more about the prevalence of, and factors associated with, obesity in preschoolers.

Failure of a prospective trial to detect cytomegalovirus retinitis after initiation of highly active antiretroviral therapy.

Thirty-one patients with AIDS with CD4+ T-cell counts of less than 75/mm3 were enrolled in a prospective study to determine the incidence of cytomegalovirus (CMV) retinitis and changes in CD4+ T-cell counts and viral loads following initiation of highly active anti-retroviral therapy (HAART). Patients were assessed using an Amsler grid, a visual field test, a questionnaire, and direct and indirect funduscopy. Only one patient developed an opportunistic infection, and the majority of patients had a threefold decrease in their viral loads and an increase in CD4+ T-cell counts within 2 months of initiating HAART. These findings support the belief that recent therapies modify the natural history of HIV infection and that new clinical approaches will be needed to address the changing profile of HIV/AIDS patients. None of our patients developed CMV retinitis. The findings add to those of other researchers, and suggest that if CMV retinitis does develop after HAART, it is an unusual finding that may be due to preexisting, subclinical retinitis rather than failure of HAART to reconstitute full immune cell recovery.

Lead poisoning and associated risk factors among preschoolers enrolled in a Head Start program.

Despite the fact that lead poisoning is one of the most common pediatric health problems in the United States today, little is known about the prevalence and correlates of this disease among nonurban preschool children living in the southern United States. The purpose of this study was to measure the prevalence of abnormal lead levels and to explore the relationships between lead levels and gender, weight, hemoglobin, and ethnicity. Using a chart review protocol, data were collected from 81 charts of children enrolled in a Head Start program in Florida. The prevalence rate of elevated lead levels was 18.5%, a rate higher than that found in most previous research. No relationship was found between lead levels and gender, weight, hemoglobin, and ethnicity. The results highlight the importance of local screening efforts. Controversies in screening are discussed in this article in some detail with the aim of assisting health care providers make decisions about whether universal screening for lead levels in children is appropriate and whether use of the Centers for Disease Control questionnaire has sufficient value. Further study is needed regarding prevalence rates in different geographic areas in the United States, and factors associated with elevated lead levels.

Health perceptions and behaviors of school-age boys and girls.

This study described and compared the health perceptions and behaviors of 83 school-age boys and girls. An age-appropriate interview schedule was designed to collect data related to demographic characteristics, health perceptions, safety, life-style practices, nutrition, dental health, and care of minor injuries. Findings indicated that most boys and girls viewed themselves as healthy and managed their own care fairly well in the areas of seat belt use, exercise, and dental health. Nutrition was identified as an area of concern, with 10% of the children skipping breakfast, and over half eating snacks with empty calories. Generally, children were found to be knowledgeable in the management of simple injuries and how to respond in the event of an emergency. Boys and girls were similar in all areas of health perceptions and behaviors except for dental health, with boys reporting more regular visits to the dentist than did girls. Further research is needed to learn more about the process by which school-age children acquire positive health behaviors to assist nurses to design and implement intervention programs that appropriately address the needs of this age group.

Methodological issues in intergenerational family nursing research.

The intergenerational aspects of family health have received little attention in nursing theory and research despite their potential to yield valuable information related to health promotion and family relationships. Methodological issues unique to intergenerational research are discussed within the phases of the research process. Strategies for avoiding methodological problems are suggested and implications for family nursing research are identified.

Child-rearing, marital, recreational and work role integration and climacteric symptoms in midlife women.

This study investigated relationships between the roles women enact during midlife and the frequency and severity of symptoms they report at the climacteric. A sample of 185 healthy, middle-aged women completed measures assessing climacteric symptoms, adjustment to the marital role, and degree of participation in child-rearing, recreational, and work roles. Findings indicated that the more roles women enact, the less likely they are to experience climacteric symptoms. Adjustment to the marital role and an active recreational role were the best predictors of infrequent and mild climacteric symptoms. The number of hours worked was negatively related to recreational involvement and marital role adjustment but did not relate to climacteric symptoms. The child-rearing role was not related to symptoms. These findings indicate that successful marital adaptation and active role participation may be significantly related to diminished climacteric symptoms formation of midlife women.

Self-reported climacteric symptoms as a function of the relationships between marital adjustment and childrearing stage.

The relationship between reported climacteric complaints of 185 healthy middle-class women between 40 and 60 years of age and marital adjustment and stages of childrearing were studied. Women low on marital adjustment had significantly more frequent and severe symptoms than women high on marital adjustment, but no differences in climacteric symptoms were reported for stage of childrearing or for the interaction between marital adjustment and stage of childrearing. Physical and psychosocial factors that may be related to the symptoms should be assessed before intervention strategies for midlife complaints are begun.