Developing the next generation of nurse scientists.

This article describes an undergraduate nursing research internship program in which students are engaged in research with a faculty mentor. Since 2002, more than 130 undergraduate nursing students have participated. Interns coauthored publications, presented papers and posters at conferences, and received awards. This highly successful program provides a model that can be easily replicated to foster the development of future nurse scientists.

Developing an interactive story for children with asthma.

Despite advancements in asthma treatment and diagnosis, asthma still remains the number 1 cause for hospitalizations in school-aged children. This usability study aimed to develop a child-friendly interactive narrative, Okay with Asthma v2.0, based on the Biopsychosocial Family Model using feedback from children. This fun and kid-friendly program encourages children to manage their own asthma with the help of peers, families, communities, and health care services. With these support structures, children can identify and avoid triggers, monitor their asthma, manage their condition with medications based on an action plan, and learn to live happily with asthma.

Promoting normal development and self-efficacy in school-age children managing chronic conditions.

Chronic conditions can affect school-age children in more ways than just physically. Normal childhood maturation is critical at this age, yet daily management of chronic symptoms can be challenging. This article describes 4 common childhood chronic illnesses (asthma, seizure disorders, diabetes, and cystic fibrosis), and the impact these conditions have on the developing child. Self-efficacy, the belief that one can effectively perform necessary skills, is essential to self-management of chronic conditions and contributes in a positive way to the child's normal development. Implications for clinical practice and future research are discussed.

Effect of peak flow monitoring on child asthma quality of life.

The purpose of this study was to evaluate the effect of peak flow monitoring on asthma quality of life (QOL) for school-age children with asthma (N = 77) who participated in a 16-week asthma self-management program. QOL was measured using the Children's Health Survey for Asthma. Findings indicated significant improvement in asthma QOL from baseline to Week 16 and higher QOL scores for those with better asthma health outcomes.

Smoke-free laws, gender, and reduction in hospitalizations for acute myocardial infarction.

OBJECTIVE: We examined gender differences in the incidence of acute myocardial infarction (AMI) after the passage of a smoke-free law in Lexington, Kentucky. The initial legislation had exemptions not covering manufacturing facilities and government buildings, which may have put men at greater risk for AMI. METHODS: We examined the effect of Lexington's smoke-free public places law on hospitalizations for AMI (i.e., heart attack) among men and women 40 months prior to and 32 months after enactment of the law. We used the statewide administrative database (Comp Data) for all hospital billing records for the four health-care systems in Lexington-Fayette County. Cases were included in the analysis if (1) the patient was $35 years of age; (2) the patient had a primary discharge diagnosis of AMI, with an International Classification of Diseases, Ninth Revision code in the range of 410.00 to 410.99; and (3) the date of service was between January 1, 2001, and December 31, 2006. RESULTS: Among women, AMI hospitalizations declined 23% after the law took effect. The rate of AMI events among men did not change significantly. There was an overrepresentation of women in the hospitality industry and a disproportionate number of men working in manufacturing facilities and government worksites not mandated by the law. CONCLUSIONS: We found gender differences in the reduction of AMI hospitalizations following implementation of a smoke-free law that covered only some sectors of the workforce. Enacting smoke-free laws that cover all places of employment and strengthening existing partial laws may extend protection against AMIs to female and male workers.

Icelandic and United States families of adolescents with asthma: predictors of health-related quality of life from the parents' perspective.

AIMS: To evaluate cultural differences in sociodemographic factors, illness severity and parents' perception of their adolescent's quality of life for Icelandic and USA families of adolescents with asthma; and to determine predictors of parent-rated quality of life. BACKGROUND: Asthma is known to have an impact on the quality of life of affected adolescents and their families, but few studies have addressed parents' perception of their adolescent's health-related quality of life. DESIGN: Cross-sectional exploratory study. METHOD: The study involved families of adolescents with asthma included 15 from Iceland and 15 from USA, recruited from paediatric practices. Parent and adolescent participants completed questionnaires; this study is based on the parent responses. Data were collected from January-May 2006. FINDINGS: While parents from Iceland and USA were similar in demographic characteristics, parents from Iceland rated their children's health-related quality of life (PedsQL(TM) 3.0, Varni 1998) more positively than did USA parents, even though Icelandic parents were more likely than their USA counterparts to report that their adolescent's asthma is severe. Significant predictors of parent-rated quality of life included location (higher scores for Icelandic parents), gender (higher scores for parents of boys), exposure to second hand smoke in the home (higher scores for those not exposed) and frequency of troublesome wheezing (higher scores for lower frequency). CONCLUSION: Quality of life has been acknowledged as an essential health outcome measure. Even though gender difference was not found in asthma severity, parents of boys perceived their adolescent's quality of life as more positive compared with parents of girls. It might be helpful for Icelandic and USA families to integrate into care delivery models, cultural differences in parent-rated quality of life. RELEVANCE TO CLINICAL PRACTICE: Asthma management interventions may improve quality of life for adolescents with asthma by reducing symptoms. Interventions promoting smoke-free homes and enhanced self-monitoring to prevent exacerbations may improve quality of life.

Adolescents with asthma: predictors of quality of life.

AIM: This paper is a report of a study to determine the demographic, personal, interpersonal and illness factors associated with asthma quality of life (QOL), as self-reported by adolescents from the United States of America (USA) and Iceland. BACKGROUND: Asthma affects 12% of children in the USA and an estimated 9% in Iceland. Limited research has addressed asthma QOL for adolescents. METHODS: This cross-sectional exploratory study included adolescents with asthma (n = 15 from the USA; n = 15 from Iceland), aged 13-17 years, primarily recruited from paediatric practices in central Kentucky, USA and Reykjavik, Iceland. Data were collected in 2006. Adolescents in the USA (47% male) had a mean age of 14.1 years (sd = 1.5); Icelandic adolescents (73% male) had a mean age of 15.1 years (sd = 1.4). Participants completed questionnaires measuring sociodemographic and asthma characteristics, degree of limitations due to asthma, self-rated health, depressive symptoms and asthma QOL. Multiple regression was used to determine predictors of asthma QOL. RESULTS: Gender was statistically significantly associated with QOL. The difference in QOL between adolescents in the USA and Iceland was not statistically significant. Statistically significant predictors of higher asthma QOL were a better rating of overall health (P < 0.01), not having had a severe asthma attack in the last 6 months (P < 0.01), and lower depressive symptoms (P < 0.05). CONCLUSION: Interventions designed to decrease depression and prevent asthma exacerbations may improve QOL for adolescents with asthma.

Reduction in asthma-related emergency department visits after implementation of a smoke-free law.

BACKGROUND: Secondhand tobacco smoke increases the risk for the development and increasing severity of asthma among adults and children. Reducing exposure to secondhand smoke decreases symptomatic exacerbations among patients with asthma. Emergency department (ED) visits for asthma were assessed before and after the implementation of smoke-free legislation in Lexington-Fayette County, Ky. OBJECTIVE: To evaluate the effects of a smoke-free law on the rate of ED visits for asthma. METHODS: The study included ED visits for asthma from 4 hospitals in Lexington-Fayette County, Ky. Age-adjusted rates of asthma ED visits were determined. Poisson regression analysis of ED visits from January 1, 2001, to December 31, 2006 compared the ED visit rates between prelaw and postlaw, adjusting for seasonality, secular trends over time, and differences among demographic subgroups. The actual rates were graphed with the Poisson curve showing the rates predicted by the model. A second prediction curve was generated to show the projected rates in the postlaw period if the law had not been implemented. RESULTS: Adjusting for seasonality, secular trends, and demographic characteristics, ED visits for asthma declined 22% from prelaw to postlaw (P < .0001; 95% CI, 14% to 29%). The rate of decline was 24% in adults age 20 years and older (P < .0001), whereas the decrease among children 19 years or younger was 18% (P = .01). CONCLUSION: Although this study did not establish causation, the smoke-free law was associated with fewer asthma ED visits among both children and adults, with a more significant decline among adults.

Medication adherence in patients who have heart failure: a review of the literature.

Data indicate that nonadherence plays a major role in preventable rehospitalizations. The first step to improving adherence is determining the affecting factor. This article critically reviews the literature on factors affecting medication adherence in heart failure patients. Findings about effects of age, gender, race, and living status on adherence are quite inconsistent. Patients who believe taking medications is beneficial or who have no side effects are more adherent, as are those highly motivated to improve their well-being. Forgetfulness, social support, and patient-provider relationship are related to adherence. Providers seeking to increase adherence must consider patients' expectations for their health, their environment, their barriers to following prescribed regimen, and their understanding of their condition and how it relates to medication taking.

Issues related to children participating in clinical research.

Research involving children is necessary to bridge the gap created by years of applying the findings of adult clinical trials to children. Given the mandate from the National Institutes of Health to include children in clinical trials, pediatric nurses will undoubtedly be asked to assist with pediatric research projects. Nurses working with children must consider the unique legal and ethical issues surrounding children as study participants. The purpose of this article is to examine issues related to children participating in clinical research. A review of pertinent literature is summarized, and practical approaches to the recommendations are discussed.

Testing an intervention to promote children's adherence to asthma self-management.

PURPOSE: To test the hypothesis that compared with the control group, 7 through 11-year-old children with persistent asthma who received asthma education plus a contingency management behavioral protocol would show higher adherence to peak expiratory flow (PEF) monitoring for asthma self-management and would report fewer asthma episodes. DESIGN AND METHODS: A randomized, controlled trial was conducted with 77 children with persistent asthma in a southeastern U.S. state. Both the intervention and control groups received instruction on PEF monitoring. Only the intervention group received asthma education plus contingency management, based on cognitive social learning theory, including self-monitoring, a contingency contract, tailoring, cueing, and reinforcement. At-home adherence to daily PEF monitoring during the 16-week study was assessed with the AccuTrax Personal Diary Spirometer, a computerized hand-held meter. Adherence was measured as a percentage of prescribed daily PEF uses at Weeks 4 (baseline), 8 (postintervention), and 16 (maintenance). RESULTS: At the end of the baseline period, the groups did not differ in adherence to daily PEF monitoring nor at Week 8. At Week 16, the intervention group's adherence for daily electronically monitored PEF was higher than that of the control group. Children in either group who were >or= 80% adherent to at least once-daily PEF monitoring during the last week of the maintenance period (weeks 8 to 16) were less likely to have an asthma episode during this period compared with those who were less adherent. CONCLUSIONS: The intervention to teach children to adhere to the recommended regimen for managing their asthma at home was effective.

Improved health outcomes with peak flow monitoring for children with asthma.

PURPOSE: Evaluate the effects of peak flow monitoring (PFM) on health outcomes of school-age children with asthma. METHOD AND SAMPLE: Seventy-seven children who previously relied on symptom monitoring were taught PFM. Adherence to PFM during the 16-week study was assessed by a computerized monitor. Health outcomes over time were based on parent report. RESULTS: Decreases occurred from baseline to week 16 in the incidence of one or more asthma episodes (p = 0.0002), physician/clinic visits (p = 0.0002), emergency department visits (p = 0.03), and missed school days (p = 0.002). CONCLUSIONS: PFM significantly reduced pediatric asthma morbidity in this sample.

Self-concept and health locus of control: factors related to children's adherence to recommended asthma regimen.

PURPOSE: To determine the relationships of adherence to daily peak expiratory flow rate (PEFR) monitoring, recommended for asthma self-management, with self-concept and health locus of control in a sample of 42 children, ages 7 through 11. DESIGN/METHODS: Secondary analysis was conducted on data collected as part of our 5-week randomized, controlled asthma self-management clinical trial. During the study, the Piers-Harris Children's Self-Concept Scale (PHCSC) and Children's Health Locus of Control Scale (CHLOC) were administered at baseline (Week 1) and Week 5 for comparison, while adherence to electronically-measured peak flow monitor (PFM) was evaluated during Week 5. RESULTS: Adherence was positively correlated with higher self-concept (r(s) = .33, p = .03) and internal health locus of control (r(s) = .30, p = .05). Adherence to PFM and the intellectual and anxiety subscales of the PHCSC also were positively associated (r(s) = .38, p = .01, in both cases). CONCLUSIONS: Children who have a positive self-concept, particularly in the areas of intellect and anxiety, are more adherent to their recommended asthma regimen. Similarly, those who perceive their ability to control their health more positively adhere better to daily PEFR monitoring. These results suggest that children's adherence interventions may need to include components aimed at enhancing self-concept and health locus of control.

Vitamin D receptor variants in 192 patients with schizophrenia and other psychiatric diseases.

Intriguing parallels have been noted previously between the biology of Vitamin D and the epidemiology of schizophrenia. We have scanned the Vitamin D receptor (VDR) gene by DOVAM-S (Detection of Virtually All Mutations-SSCP), a robotically enhanced multiplexed scanning method. In total, 100 patients with schizophrenia (86 Caucasians and 14 African-Americans) were scanned. In addition, pilot experiments were performed in patients with bipolar disorder (BPD) (24), autism (24), attention deficit hyperactivity disorder (ADHD) (24), and alcoholism (20). A total of 762 kb of the VDR genomic sequence was scanned. R208N and V339I were each found in one African-American patient, while absent in 35 African-American controls without schizophrenia (2/14 versus 0/35, P=0.08). Within the power of the study (> or =1.6-fold relative risk), the common M1T variant is not associated with schizophrenia. In the 92 scanned patients with other psychiatric diseases, R173S was found in a single patient with bipolar disorder. In conclusion, we describe three novel structural variants of the Vitamin D receptor. Further study is required to clarify their role, if any, in psychiatric disease.

An evaluation of children's metered-dose inhaler technique for asthma medications.

Regardless of the medication delivery system, health care providers need to teach accurate medication administration techniques to their patients, educate them about the particular nuances of the prescribed delivery system (eg, proper storage), and reinforce these issues at each health encounter. A single instruction session is not sufficient to maintain appropriate inhaler techniques for patients who require continued use. Providing written steps for the administration technique is helpful so that the patient can refer to them later when using the medication. The National Heart, Lung, and Blood Institute's "Practical Guide for the Diagnosis and Management of Asthma" recommends that practitioners follow these steps for effective inhaler technique training when first prescribing an inhaler: 1. Teach patients the steps and give written instruction handouts. 2. Demonstrate how to use the inhaler step-by-step. 3. Ask patients to demonstrate how to use the inhaler. Let the patient refer to the handout on the first training. Then use the handout asa checklist to assess the patient's future technique. 4. Provide feedback to patients about what they did right and what they need to improve. Have patients demonstrate their technique again, if necessary. The last two steps should be performed (ie, demonstration and providing feedback on what patients did right and what they need to improve) at every subsequent visit. If the patient makes multiple errors, it is advisable to focus on improving one or two key steps at a time. With improvements in drug delivery come challenges, necessitating that practitioners stay current with new medication administration techniques. Teaching and reinforcing accurate technique at each health care encounter are critical to help ensure medication efficacy for patients with asthma. Since one fifth of children in the study performed incorrect medication technique even after education, checklists of steps for the correct use of inhalation devices, such as those provided in this article, should be given to patients for home use and for use by clinicians to evaluate patient technique at each health encounter.

Children's self-reports of characteristics of their asthma episodes.

Our purpose was to examine school-age children's self-reports of characteristics of their asthma episodes including the precipitating events, symptoms experienced during the episodes, and interventions used to resolve the episodes. Children's self-reports of their asthma episodes were assessed over a 6-week period for 42 children with persistent asthma who participated in a randomized, controlled clinical trial to evaluate the efficacy of an asthma self-management program on adherence to recommended daily peak expiratory flow rate monitoring. Children were instructed to answer the following questions on the Asthma Report Form each time they experienced an asthma episode: 1) What were you doing; 2) How did you feel; and 3) What did you do to help your breathing? Of the children, 71% experienced at least one asthma episode during the 6 weeks. There were a total of 206 episodes. Physical activity (51%) was the most cited trigger, cough alone or combined with other symptoms (84%) was the predominant symptom, and rescue asthma medication (59%) was identified most often as the intervention used by the children to resolve the asthma episode. Children's self-reports provided valuable information about their asthma episodes. The finding that most of the children experienced at least one asthma episode during the 6-week period underscores the importance of family education on how to handle asthma episodes effectively at home. Because physical activity was cited most often as a trigger for asthma episodes, families should receive education on preventive steps for averting an asthma episode prior to the child engaging in physical activity.

Children's adherence to recommended asthma self-management.

PURPOSE: Adherence to peak expiratory flow rate monitoring by children with asthma was evaluated, and a behavioral strategy to enhance adherence to daily monitoring was tested. DESIGN AND METHODS: Forty-two 7- through 11-year-old children with persistent asthma were recruited into a 5-week randomized, controlled clinical trial. Adherence data were collected electronically by PeakLog and the self-report Asthma Diary. RESULTS: Adherence declined over time. At week 5, intervention group adherence (Median = 79%) was higher than the usual care group adherence (Median = 64%), but the difference was not statistically significant. The effect size did suggest that differences between groups were present. CONCLUSIONS: Even small improvements in adherence to asthma treatment may be clinically significant in light of the alarming increases in asthma morbidity and mortality. Contingency management shows promise for improving adherence outcomes. Future research should engage larger sample sizes and increase the number and intensity of sessions to teach behavioral strategies.