Unrecognized high blood pressure. A major public health issue for the workplace.

Hypertension continues to be prevalent in the general population despite the public's increased awareness of cardiovascular disease. Population-wide detection and prevention of hypertension are high priority goals within preventive health care. According to recent National Heart, Lung, and Blood Institute (NHLBI) guidelines, high normal blood pressure (BP) (systolic 130 to 139 mm Hg or diastolic 85 to 89 mm Hg) is not an innocuous condition (NHLBI, 1997). High normal BP is a detectable, modifiable, antecedent condition to overt hypertension. Little is known about the incidence of high normal BP in the general population and of its relationship to stress. This study examined the prevalence of high normal and hypertensive levels of blood pressure in a convenience sample of 94 volunteer employees from a midsize corporation. Blood pressure and level of reported stress were assessed. Findings revealed rates of 11% and 30% high normal and hypertensive blood pressure levels, respectively. Ninety-six percent of participants assumed their blood pressures were normal. As in other studies, those employees with hypertensive blood pressure reported higher stress levels than normotensive employees. However, the population with high normal BP did not report significantly higher stress levels than normotensive employees. These findings suggest high normal and hypertensive blood pressures are prevalent cardiovascular disease risk factors among employees in the workplace. Most employees are unaware of their elevated BP and the risk of high normal BP. Occupational health nurses are in a strategic position to take a proactive approach to population-wide hypertension prevention by initiating worksite BP screening and education programs.

Reproductive decision making in mothers with HIV-1.

Eighty percent of women with human immunodeficiency virus (HIV) are of childbearing age and the incidence of HIV in women is rapidly increasing. Despite the risk of perinatal transmission and The Centers for Disease Control's (CDC) recommendation that HIV-positive women delay pregnancy, HIV-infected women continue to become pregnant and have children. To gain insight into reproductive decision-making of women with HIV, 25 mothers who participated in a natural history study of perinatal HIV transmission were interviewed using open-ended questions based on Fishbein's Theory of Reasoned Action. Three major themes emerged from the content analysis of transcripts from interviews with HIV infected women: (1) motherhood viewed as a joy and a means of meeting their own needs, (2) concerns about their children's well-being, and (3) the minor role of HIV infection in their lives. Women reported negative reactions to providers who focused exclusively on their HIV status, and not on the need to view the women's lives as a whole.

Hormone therapy and breast cancer.

Use or nonuse of hormone therapy (HT) is a controversial decision for menopausal women that has taken on increasing significance as the large number of baby boomers enter this life stage. Studies suggest benefits of HT for prevention of osteoporosis and coronary artery disease, as well as a possible increased risk for cancer, particularly breast cancer. Because of this risk for breast cancer, women with a family history may feel differently about HT. However, differences have not been studied. The purpose of this study was to examine differences in attitudes toward HT of menopausal women with and without a family history of breast cancer. A nonexperimental, cross-sectional design was used. The setting included various sites located in a rural community in northwestern Pennsylvania. A convenience sample of 110 was obtained. A Health Belief Model attitudinal scale was completed by the participants. Although there were no significant differences in attitudes toward HT between the groups, ancillary analysis revealed a significant difference (P = .04) in frequency of reported fear of breast cancer regarding HT in those women with a family history of breast cancer and those without such a history. The findings of this study point to a need for further research on attitudes of women regarding HT and how they may affect postmenopausal healthcare management.

HIV, pregnancy, and zidovudine: what do women know?

AIDS is a major cause of death among women and children, representing the fourth leading cause of death among women ages 25 to 44 and the seventh leading cause of death among children ages 1 to 4 in the United States. In 1994, National Institutes of Health announced the findings of the AIDS Clinical Trials Group study (076) that found that the use of the antiretroviral drug zidovudine (AZT) reduced perinatal transmission of HIV by two thirds. These findings have direct implications for the growing number of women with HIV disease, their children and families, and the multiple systems that deliver ongoing services and care. In response to these findings, complex clinical, legal, and ethical issues have emerged that must be addressed to decrease the incidence of perinatal HIV transmission and to provide quality health care services. The purpose of this research was to assess what HIV-infected women presently know regarding AZT use in pregnancy to reduce prenatal transmission and to identify their views of the impact of this information on reproductive decision making. A one-page survey developed for this study was used to address these questions. A convenience sample of 204 HIV-infected women completed the survey. Data from 192 were usable. Of the sample, 121 (63.7%) women reported knowledge regarding the use of AZT in pregnancy. Only 73.5% of those who reported knowledge regarding AZT prophylaxis demonstrated accurate knowledge about the effects of its use. A relationship was found between knowledge about AZT use during pregnancy and women's decision to consider pregnancy, chi 2(2, N = 146) = 32.7, p = .0001, with women who reported that they were knowledgeable about AZT prophylaxis as more likely to consider pregnancy than those who reported that they were not knowledgeable.

Reliability of maximal respiratory pressures in multiple sclerosis.

OBJECTIVE: To assess the reliability of maximal inspiratory pressure (P(I)max) and maximal expiratory pressure (P(E)max) in subjects with multiple sclerosis (MS) and healthy control subjects by identifying the number of testing sessions and the number of measurements needed in a single testing session to obtain consistent, reproducible results. DESIGN: A descriptive, comparative design with repeated measures was used. SETTING: Four sets of 10 P(I)max and 10 P(E)max measurements were obtained over a 4-week period from MS subjects in their homes. The same measurements were obtained from healthy control subjects in a private setting. SUBJECTS: Seventy-two MS patients and 61 healthy control subjects participated in the study. MEASUREMENT: P(I)max and P(E)max values were obtained by using previously published methods. RESULTS: Mean P(E)max and P(I)max values for MS patients differed over the first three of the four testing sessions. By contrast, mean P(E)max and P(I)max values for healthy control subjects differed only when the first session values were compared with values from the last three sessions. For MS patients, P(E)max and P(I)max increased between the first and 10th trial during the first testing session, but not during the subsequent three sessions. CONCLUSIONS: The results of this study suggest that several practice sessions should be provided in order to obtain reliable P(E)max and P(I)max values in persons with MS. At least one practice session should be provided for healthy control subjects before identifying a baseline.

Airway dynamics, oesophageal pressure and cough.

This study hypothesizes that: peak supramaximal airflow during cough reflects expiratory muscle effort, and that expiratory muscle function during cough might be assessed from the airflow signal alone. We monitored airflow and oesophageal pressure (Poes) in normal subjects during cough generated under two conditions: 1) voluntarily from functional residual capacity (FRC); and 2) involuntarily after inhalation of citric acid (CA). Maximal expiratory cough flow was quantified as the quotient of maximal flow during a given cough divided by maximal flow at the matched volume of thoracic gas (Vtg) as identified on the maximal expiratory flow-volume curve. We found: flow ratios correlated poorly with Poes; the variance of flow ratios associated with a series of voluntary coughs was poorly explained by Poes. During CA inhalation, when the Vtg compressed during cough could not be controlled, correlation of Poes with flow ratio remained poor. We conclude that to study the motor limb of the cough reflex, measurements of both airflow and oesophageal pressure are required.

Expiratory training in multiple sclerosis.

OBJECTIVE: To compare the effects of expiratory muscle training and sham training on respiratory muscle strength in patients with multiple sclerosis (MS). DESIGN: A randomized control trial; subjects were randomly assigned to either expiratory muscle training or sham training. SETTING: Training and measurement of respiratory muscle pressures were conducted in patients' homes. Weekly home visits were conducted to assure compliance with the training protocols and to obtain measurements. PATIENTS: Twenty subjects with clinically definite MS and decreased expiratory muscle strength entered the study; 10 subjects completed 3 months of expiratory training using a threshold training device and 5 subjects completed 3 months of sham training using the same device but without an expiratory training threshold load. MEASUREMENT: Respiratory muscle strength was assessed at baseline and after 1, 2, and 3 months of training; maximal inspiratory and expiratory pressures were used as measures of respiratory muscle strength. RESULTS: There was a significant increase in expiratory muscle strength after 3 months of training when the expiratory training group was compared to the sham group (p = .003); no significant change in inspiratory muscle strength was observed. CONCLUSIONS: The results of this pilot study suggest that the strength of the expiratory muscles of persons with MS can be increased through respiratory muscle training targeted to the expiratory muscles. Further research is indicated to determine if increasing the strength of the expiratory muscles in MS has an effect on clinical outcomes in this patient population.

A framework of trauma and trauma recidivism in adolescents and young adults.

Trauma resulting from violence and unintentional causes has reached epidemic proportions in the United States, particularly among urban adolescents and young adults. Many of these injuries can be predicted because of participation of adolescents and young adults in risky behaviors. In addition, subsequent injuries to survivors can be predicted because of their return to risk taking behavior. This paper presents a model that addresses risk-taking behaviors, antecedents to risk taking, and the possible outcomes, including trauma and trauma recidivism. It focuses attention on the growing problem of trauma and trauma recidivism among adolescents and young adults and identifies implications for research and practice for trauma nurses.

Risk factors of adolescent and young adult trauma victims.

BACKGROUND: Repeated injury, or recidivism, because of intentional or unintentional injury is a growing chronic health problem among urban adolescents and young adults in the United States. OBJECTIVE: To describe demographic, social, environmental, psychological, and developmental antecedents and risk-taking behaviors, and to examine their relationships to type of trauma and rate of trauma recidivism in adolescent and young adults in an urban trauma center. METHODS: One hundred adolescent and young adult trauma victims in an urban trauma center were interviewed, using the Adolescent Risk-Taking Instrument, the Brief Anger/Aggression Questionnaire, and the Trauma Risk Factor Interview Schedule. Bivariate correlation, multiple regression, and discriminant function analysis were used to examine the data. RESULTS: Of the sample, 89% experienced trauma related to interpersonal violence, including firearm injuries, stab wounds, and blunt trauma. Male gender, unemployment, past arrest, lower levels of spirituality, and higher levels of anger/aggression and thrill-seeking accounted for 25% of the variance in the number of risk-taking behaviors. Factors such as male gender, past arrest, unemployment, having been a crime victim in the past, lower autonomy, use of weapons, fighting, and no psychological counseling distinguished subjects with firearm-related injuries from subjects with other injury sources. Use of alcohol on weekdays, past arrest, and higher education levels were associated with trauma recidivism, explaining 14% of the variance. CONCLUSIONS: Social/environmental and psychological/developmental variables, as well as risk-taking behaviors, are important correlates of trauma and recidivism. These findings suggest the importance of advocacy for social policies conductive to reducing the risks of violence and trauma and risk-reduction interventions as components of posttrauma care.

Betaseron: the new MS treatment.

Betaseron is a new medication that decreases the frequency and severity of exacerbations in persons with relapsing-remitting MS. It is the first to alter the disease itself and has, therefore, generated considerable hope among patients, families and health care providers. Patients who meet the criteria for use of Betaseron will be confronted with a number of decisions and cost factors. Further, they must be willing to prepare and administer Betaseron injections. Potential adverse effects, direct and indirect costs of Betaseron, and administration and monitoring requirements determine the nursing implications. To provide optimum care and education to patients with MS, nurses must maintain current knowledge about this new medication.

Comparison of tidal volumes obtained by one-handed and two-handed ventilation techniques.

OBJECTIVES: To compare tidal volumes delivered by one- vs two-handed compressions of a manual resuscitation bag and assess the effects of subject characteristics on those tidal volumes. DESIGN: Subjects (108 healthcare providers from a 500-bed teaching hospital) were assigned randomly to one of two procedures: one- followed by two-handed compression or two- followed by one-handed compression. A 1-liter resuscitation bag, lung performance analyzer and Wright spirometer were used to measure tidal volume. Data collection occurred in a simulated situation. RESULTS: There was a significant difference in tidal volume delivered by one-handed (mean = 694 mL, SD = 111) vs two-handed compressions (mean = 827 mL, SD = 113). Hand size, grip strength, height and weight were correlated with tidal volumes generated by one-handed and two-handed procedures. No other subject characteristics were correlated with tidal volumes. CONCLUSIONS: Tidal volumes delivered by healthcare providers using one- vs two-handed compressions were found to be significantly different, with those delivered by two hands significantly greater than those delivered by one hand. Strength of hand grip was the best predictor of volume delivered and was more strongly correlated with volumes delivered by one rather than two hands.

Women and AIDS: sociopolitical issues.

HIV infection and AIDS in women will continue without adequate diagnosis and treatment as long as women are not treated as full partners in society. Until issues related to women and their place in society are considered within the sociopolitical context, women who are at risk for HIV infection, those infected with the HIV virus, and those with AIDS will continue to receive inadequate attention. The National Center for Nursing's National Action Agenda, Nursing and the HIV Epidemic, provides some direction for addressing these issues and those that relate to practice, education, research, and health policy. It is incumbent on nurse researchers to conduct research related to the critical issues associated with HIV infection and AIDS in women, disseminate the findings of that research, and use those findings to inform and move health policy in this area forward. It is equally important to understand the issues that affect women--ethnic considerations, sexual practices, IV drug use--within the context or present political climate of our society. That climate allowed an NIH study that could identify risky sexual behaviors of adolescent and adult subjects who consent to participate in such a study to be called to a halt--not because of concerns about the study design or the scientific rigor of the study, but because of an elected official's fear that asking such questions will encourage these behaviors and his personal belief that such issues should not be discussed in polite society. These issues must be brought forward, acknowledged, and discussed if they are to be dealt with effectively. Otherwise, the relentless course of AIDS will continue.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitudes of nurses toward computerization: a replication.

To assess the attitudes of nurses toward computerization, Stronge and Brodt's questionnaire, Assessment of Nurses' Attitudes Toward Computerization was used to survey head nurses, staff registered nurses, and licensed practical nurses in a 500-bed hospital. Nurses' attitudes were generally favorable toward computers and there were no significant differences in attitudes by nurses' job title, level of education, age, or years of nursing experience. Previous experience with computers was the only variable significantly related to total mean score with those nurses who had previously used computers having significantly (p less than 0.001) more favorable attitudes toward computers than those who reported no previous computer use. A factor analysis was obtained; five factors emerged. Although the factors are similar to the categories identified by Stronge and Brodt, results of the factor analysis suggest response bias.

Respiratory function in multiple sclerosis. Utility of clinical assessment of respiratory muscle function.

PURPOSE: The aim of this study was to assess the utility of clinical assessment of respiratory muscle weakness in MS. PATIENTS AND METHODS: We studied 40 MS patients who performed pulmonary function tests using standard procedures and measures of respiratory muscle strength. Descriptive clinical indices included a history of detailed neurologic findings, including upper and lower extremity weakness, cerebellar signs, and evidence of cerebral lesions and other clinical signs including dependence in activities of daily living, shortness of breath, weak voice, dysarthria and dysphagia. We devised an index comprised of four clinical signs: the patient's report of difficulty in clearing pulmonary secretions and his report of a weakened cough, the examiner's observation of the patient's cough, and ability to count on a single exhalation. RESULTS: Mean values of TLC (95 percent +/- 14) VC (91 percent +/- 19), and RV (106 percent +/- 34) were normal. By contrast, MVV (68 percent +/- 20), PImax (74 percent +/- 27) and PEmax (51 percent +/- 22) were decreased. Stepwise multiple regression indicated that the best single predictor of expiratory muscle weakness was the index score; the combination of index score, upper extremity weakness, and maximal voluntary ventilation accounted for 60 percent of the variance in PEmax. CONCLUSION: We conclude that clinical assessment is a better predictor of respiratory muscle weakness than spirometry and that a systematic clinical assessment supplemented by respiratory muscle assessment and MVV can uncover subtle respiratory muscle weakness in patients with MS.

Use of the Trajectory Model of nursing in multiple sclerosis.

Multiple sclerosis (MS) is a chronic, demyelinating disorder that is unpredictable in its overall course, in the type of symptoms that will predominate, and in its eventual outcome. It has been used as a model in research, education, and practice to examine the course of chronic illness, patient and family responses, coping and adjustment to chronic illness, and specific concepts and variables of interest to researchers. MS is used in this paper to evaluate for nursing practice the utility of the Corbin and Strauss trajectory model of nursing. The assumptions and major concepts of the trajectory framework are discussed, use of the model in multiple sclerosis is demonstrated, and the strengths and limitations of the framework as a nursing model are identified.

Testing of an Index of Pulmonary Dysfunction in Multiple Sclerosis.

The reliability and validity of an Index of Pulmonary Dysfunction in Multiple Sclerosis (Index) comprised of four readily assessed clinical signs was studied. Forty patients with MS performed pulmonary function testing and underwent clinical evaluation to determine whether or not the Index correctly identified those patients with pulmonary dysfunction. The Index correctly predicted the presence or absence of significant respiratory muscle weakness (defined as Pemax less than 50% of predicted) in 32 (80%) of the subjects. All subjects who had normal expiratory muscle strength (Pemax greater than or equal to 80% of predicted) were correctly classified by the Index; however, not all patients with isolated expiratory muscle weakness were correctly identified. Test-retest reliability, interrater reliability (Spearman rho coefficients of 0.87 and 0.94, respectively), and internal consistency (alpha = .83) of the Index were acceptable. Index scores were not associated with changes in any other PFT results except residual volume, which increased with the severity of respiratory muscle weakness. The Index has acceptable validity and reliability for use in clinical practice to identify those neurological patients with expiratory muscle weakness.