Stress, health, and depressive symptoms in older adults at three time points over 18 months.

This descriptive study is a secondary analysis of data that examined depressive symptoms in a random sample of 429 community-dwelling adults aged 65 years and older. Participants were classified as having consistently high (n = 20). consistently low (n = 327), or fluctuating (n = 82) levels of depressive symptoms, based on scores from the Center for Epidemiological Studies-Depression Scale (CES-D; L. S. Radloff, 1977) at three time points over the course of 18 months. Differences in stress (life events and daily hassles), health (self-assessed health and physical complaints), and biographic variables among the 3 groups were examined. One quarter of the sample reported high depressive symptoms at least once over 18 months. There were significant differences among the 3 symptom groups on each of the stress and health measures and on marital status. The findings support the relationship among stress, health, and depressive symptoms over time. Implications for clinicians and researchers are discussed.

Interpreting bodily changes as illness: a longitudinal study of older adults.

Research on elders' health behavior has largely ignored the stage between experiencing a bodily change and defining it as an illness. This paper addresses the question of what explains such definitions of bodily complaints as illness symptoms. The issue is examined in a longitudinal study with a random sample of 350 community dwelling persons aged 65 and over. Multiple regression was used to analyze the effects of external stresses, psychological factors and health attitudes as well as contextual variables, on three types of illness representations. These consisted of giving the bodily changes an illness label, initiating contact with a physician, and/or using some form of self care. These illness representations were treated as outcome variables singularly and in combination. The findings revealed that the overall frequency of a person's bodily changes was the best predictor of an illness designation. Other significant predictors at Time 4 of the study included belief in the seriousness of a complaint, the occurrence of prior illness representations and self-assessed health. This research study on the elderly is unique in that it seeks to explain, within a longitudinal design, the intermediate step between the experience of a bodily change and the definition of the change as an illness.

Structural equation modeling and its relationship to multiple regression and factor analysis.

Using a conceptual and nontechnical approach, the meaning of structural equation modeling (SEM) and the similarities to, and differences from, more commonly used procedures such as correlation, regression, path analysis, and factor analysis are explained. Application of the statistical technique is presented using data from a study of the relationships among stresses, strains, and physical health in a random sample of 492 community-dwelling elders aged 65 and older. Advantages of each statistical procedure are described. Theoretical issues related to the use of each procedure are presented with emphasis on the need for a sound theoretical model and match between the statistical procedure and the aims of the analysis.

Triaging and interpreting chest pain.

This article discusses a research-based approach to the assessment and interpretation of chest pain, including the use of findings from the history and physical examination, electrocardiogram, and other tests. The focus is on recognition of abnormal findings suggestive of diagnosis of myocardial infarction and unstable angina. Recommendations from the literature are provided to assist the practitioner in triage and interpretation.

Effect of cardiac surgery patient characteristics on patient outcomes from 1981 through 1995.

BACKGROUND: Previous studies have demonstrated increased risk in patients undergoing coronary artery bypass surgery (CABG), but the effect of this increasing risk on outcomes has not been well documented. The purposes of this study were (1) to evaluate patients who had CABG from 1993 to 1995 (group III) and compare them with patients from 1981 through 1987 (group I) and 1988 through 1992 (group II) to determine if the trend toward higher-risk patients continued and (2) to evaluate what effect risk had on in-hospital outcomes. METHODS AND RESULTS: Data were collected prospectively on patients undergoing CABG. Patients from the three time periods were compared by use of univariate and multivariate statistics. Risk models for mortality were developed by use of logistic regression. Significant changes were noted in the three time periods, with risk increasing over time. Increased risk was associated with increased mortality in group II, but mortality declined in group III despite the continued increase in patient risk. Group II had an increase in complications, with little change in group III. The actual mortality rate was lower than predicted in group III. CONCLUSIONS: Patients undergoing CABG are increasingly high risk. In-hospital mortality rates declined during the period from 1993 through 1995 and were lower than predicted despite the increase in risk. This decreased mortality rate may reflect greater experience in providing care to high-risk patients and improved myocardial protection and surgical and anesthetic techniques. Although continued analysis of patient risk and benefit is needed, researchers must be cognizant of the rapid changes in technology and knowledge and should correlate changes in the process of care with outcomes.

Elderly persons' interpretation of a bodily change as an illness symptom.

Based on a community random sample of 406 elderly, factors that persuade an elderly person to interpret a bodily change as a symptom of illness are described. Three measures of such illness interpretation among 27 different bodily changes are used in analysis: giving an illness label to the change, consulting a physician for it, and/or using self-care for treatment. The three types of representations across all 27 bodily changes taken together, as well as among five typical complaints most commonly experienced, are reported. The findings show that the perceived seriousness of the bodily change and the general health context of the older person in which it has occurred are conducive to interpreting a bodily change as an illness symptom.

Economic winners and losers after introduction of an effective new therapy depend on the type of payment system.

An effective therapy for a costly illness has economic consequences. There may also be differences between provider costs and payer costs and initial versus long-term costs; costs may also vary with the reimbursement scheme. Consider the case of an effective therapy to prevent restenosis after coronary angioplasty. Assume that the initial provider cost of angioplasty is $12,000 and that restenosis within 6 months results in repeat angioplasty in 20% of cases, with a follow-up cost of $2,400, or $14,400 total. Assume that a therapy costs $1,000 per angioplasty and decreases restenosis by 50%, resulting in repeat angioplasty in 10% of cases. This will result in an initial cost of $13,000 and a follow-up cost of $1,300, or $14,300 total. The total societal costs will be -$100, a slight savings. Thus, the $1,100 cost of therapy is offset by reduced costs associated with restenosis, and the societal costs are almost neutral. Assume that under fee for service providers charge costs plus 10% and that without the new therapy either a package price or a capitated system is revenue neutral. Changes in costs resulting from therapy to prevent restenosis are as follows (plus sign indicates cost or loss; minus sign indicates savings or profit): [table: see text] Under fee for service, the payer takes the risks, and the economic consequences to providers are minimal. The situation is reversed under capitation. For whoever takes the risk, there is an initial loss to pay for the therapy, but a long-term gain due to less restenosis. Under package pricing, the providers lose because of the cost of therapy and fewer procedures, while the payers gain. A new therapy, even if it is revenue neutral to society overall, may have considerable economic consequences, which vary with time and with the different perspectives of providers and payers.

Somatic awareness and coronary artery disease in women with chest pain.

OBJECTIVE: To determine if there was a relationship between level of somatic awareness and coronary artery disease (CAD) in women with chest pain. DESIGN: Descriptive, correlational study. SETTING: Urban, university-affiliated, tertiary care hospital. SAMPLE: Fifty-five women without a previous history of heart disease admitted to the hospital for evaluation of chest pain. MEASURES: Modified Somatic Perception Questionnaire (MSPQ); Patterson and Horowitz clinical criteria for classification of chest pain; Supplemented Rose Questionnaire for angina; age; and CAD risk factors. RESULTS: A small but significant inverse correlation was found between level of somatic awareness as measured by MSPQ scores and degree of CAD (r = 0.2932, p < 0.05). MSPQ scores significantly differed between women with CAD (lower scores) and women without CAD (higher scores) (p < 0.05). MSPQ score was the most important factor in a logistic regression model that modestly but significantly predicted presence or absence of CAD. CONCLUSIONS: Somatic awareness may be an important factor to consider in evaluating the awareness and response of women to symptoms of myocardial ischemia and to chest pain of both cardiac and noncardiac etiologies.

Internal cardioverter defibrillator device discharge: experiences of patients and family members.

PURPOSE: The purpose of the study was to describe sensations, symptoms, and experiences of internal cardioverter defibrillator (ICD) activations from the perspective of patients and a member of their family. METHODS: A prospective, descriptive study with qualitative and quantitative measures was used. Patients with an ICD returned a device activation form within 24 hours after receiving a shock and both patient and family members participated in interviews at 1, 3, and 6 months after ICD implantation. SAMPLE: Twenty-two patients with ICD (two women, 20 men) between the ages of 24 to 72 years (mean 56.5 years) and one family member per patient participated. Family members ranged in age from 43 to 67 years (mean 52.6 years) and were primarily spouses. RESULTS: The most distressing aspects of receiving a shock were lack of warning, multiple shocks, and progressively increased sensations with multiple shocks. Mean shock intensity was ranked 5.44 on visual analog scale with a range of 0 to 10. The most frequently reported symptoms and sensations were generalized nervousness and terror/fear. Dizziness, general weakness, nausea and vomiting, palpitations, and chest soreness were also noted. IMPLICATIONS: Nursing interventions related to education of patients with an ICD and their families can incorporate knowledge of these experiences to facilitate anticipatory guidance and strengthen preparation of both the patient and family member for ICD device discharge. Further research as device technology evolves is warranted.

The effectiveness of teaching a relaxation technique to patients undergoing elective cardiac catheterization.

The effects of a relaxation technique (RT) on anxiety, vital signs, procedure length, and amount of diazepam given were examined in patients undergoing cardiac catheterization (CC). Forty patients were randomly assigned to an experimental (RT) or a control (no RT) group. No significant differences were found between groups in pre-CC or post-CC State-Trait Anxiety Inventory (STAI) scores, vital signs, or procedure length. The experimental group received significantly less diazepam, and their STAI scores declined significantly.

Microderivatization of 4-[18O]hydroxyproline and quantitation with a benchtop mass spectrometer.

Accurate estimation of in vivo turnover rates of collagen is complicated by amino acid reutilization. It was previously shown that the ideal, non-recycling tracer was [18O]hydroxyproline synthesized in vivo. The analytical method for measuring turnover rates with [18O]hydroxyproline must include analyte quantitation for pool size determination and isotope ratio measurement for determining levels of label incorporation. For ease of use and widest availability, a benchtop gas chromatograph-mass spectrometer in the electron-impact ionization mode was chosen. Here we present a versatile procedure for hydroxyproline derivatization that is well suited for routine, large-scale determination of analyte concentrations and relative levels of 18O incorporation.