Disturbed sleep and preterm birth: a potential relationship?

PURPOSE: Many women report disturbed sleep during pregnancy, but its impact on clinical outcomes remains unknown. This study examined subjective sleep quality and daytime sleepiness in relation to preterm birth. METHODS: A convenience sample of 220 pregnant women completed the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Perceived Stress Scale (PSS) during the second trimester. Women who had preterm and full-term births were compared on these measures. RESULTS: The preterm birth rate of the sample was 14.6%. Sleep latency, the period from lights out to sleep onset, was significantly longer in the preterm group, which also reported a tendency to use more sleep medications, but had lower PSQI daytime dysfunction scores. Perceived stress did not differentiate preterm and full-term groups. CONCLUSION: Disturbed sleep in pregnancy may be associated with preterm birth. Future studies should examine specific physiological factors that underlie this increased vulnerability.

Managing time: the effects of personal goal setting on resource allocation strategy and task performance.

One key to understanding motivated behavior is examining the behavior of individuals as they work on multiple tasks under a time constraint. This article is an exploration of the influence of self-set goals on subsequent resource allocation to different tasks. Participants were given a variety of tasks from which they were to choose how to allocate their time and effort. Results indicated that the use of self-set goals structured the work pattern, with less switching between tasks relative to the work pattern of a group of participants who did not set goals. In addition, those who set goals reported less task-related cognitive interference, indicating that they were not as distracted while they worked. Participants who did not set goals, however, performed at a higher level on some of the tasks. It is suggested that self-set goals may often be chosen at an easily attainable level, creating a structured and focused work environment but not necessarily eliciting the motivational properties typically associated with goal setting.

Cardiac instrument development in a low-literacy population: the revised Chest Discomfort Diary.

OBJECTIVE: The purpose of this study was to pilot test a self-administered chest pain questionnaire, a revised version of the Chest Discomfort Diary (CDD-R), in a sample of patients with chronic angina selected from a population known to have low literacy. DESIGN: The study design was descriptive and correlational. SAMPLE: The study used a convenience sample of 27 subjects with documented history of coronary artery disease and angina. Characteristics of the sample included a mean age of 56.3 years (SD, 12.4 years), 88.9% African-American, and 56.3% male, and 59.3% had a history of acute myocardial infarction. Approximately 28% had achieved a 9th-grade education or less, and reading levels ranged from 4th grade to 12th grade. Subjects completed the CDD-R, a 36-item instrument reflecting multiple dimensions of anginal chest pain. RESULTS: Descriptions of the location (left chest, 66.6%), character (pressure, 59.2%), and precipitants of chest pain (walking, 51.8%) were consistent with clinical descriptions of "typical angina." Other physical symptoms such as shortness of breath (88.8%) and fatigue (85.1%) were reported. Walking (55.5%) was the activity most frequently described as difficult to perform because of chest pain, with sublingual nitroglycerin (77.7%) the most frequently used and most effective chest pain relief strategy. CONCLUSION: The CDD-R adequately measured multiple characteristics of anginal chest pain. Further research is needed to establish construct validity of the CDD-R and to determine the feasibility of using the instrument to monitor changes over time in patients' chronic angina.

Use of focus groups for pain and quality of life assessment in adults with sickle cell disease.

This study assessed the effectiveness of using focus groups to obtain information about the characteristics of pain and quality of life in adults with sickle cell disease and their families. Five focus group sessions were held. Four groups consisted of adults diagnosed with sickle cell disease and one was composed of family members. Although focus groups were useful for addressing the purposes of the study, several volunteers in the patient group were unable to attend due to the occurrence of pain episodes. Adults with sickle cell disease identified recurring disabling pain and its consequences as interfering with their physical, emotional, and social quality of life. Several reported a pain aura that signaled the initiation of a painful episode. Useful self-care techniques and coping strategies were also identified. Common emotional responses included anger, hostility, depression, disenfranchisement, death anxiety and fatalism. The belief by those with sickle cell disease that health professionals viewed them as drug dependent often fueled angry and hostile responses. Religion was a major source for coping. Family members' quality of life was affected and they felt the negative impact of sickle cell disease on family relationships. Family members also reported feelings of helplessness, guilt, and parental self-blame. Health care providers could use information gained through this study to positively influence the care of adults with sickle cell disease.

Caring for the woman with migraine headaches.

About 16% of American women experience migraine headaches. These debilitating headaches cause lost time from family, social activities, and work. Although migraines are thought to be a result of shifting menstrual and perimenopausal hormones, a physiologic connection has not been well established. This article approaches premenstrual and perimenopausal migraine headaches from a chronic disease perspective, focusing on self-care and the use of prescription and nonprescription therapies. Implications for practice and future research also are discussed.

Caring for the woman with migraine headaches.

Approximately 16% of American women experience migraine headaches. These debilitating headaches cause lost time from family, social activities, and work. Although migraines are thought to be a result of shifting menstrual and perimenopausal hormones, a physiologic connection has not been well established. Despite the lack of certainty regarding migraine cause, several theories have been postulated and a significant amount of literature has been published addressing the management of premenstrual migraines. Fewer articles have been published regarding the management of perimenopausal migraines, which are treated somewhat differently. This article approaches both premenstrual and perimenopausal migraine headaches from a chronic disease perspective, focusing on self-care and the use of prescription and nonprescription therapies. Implications for practice and future research are also discussed.

The perceptions of menopause of African-American and white women and affect on willingness to participate in a HRT clinical trial.

Menopause is a normal developmental process for women; however, few studies of healthy menopausal women and African-American women have been reported. While hormone replacement therapy (HRT) has been touted as a treatment for menopausal women, clinical trials of HRT still need to be conducted to determine its potential positive and negative effects. This is a focus group study of 21 women of menopausal age (11 African-Americans and 10 White women) to determine their experiences with menopause and their willingness to participate in a HRT clinical trial. Results indicated generally positive attitudes toward menopause and a variety of symptoms of varying degrees of severity in African-American and White women. Limited knowledge about menopause and HRT were apparent; however, White women were more likely to be receiving HRT and were more informed about HRT than African-American women. White women also were more positive about participating in a HRT clinical trial than African-American women who feared cancer as a potential side effect.

Fat distribution and cardiovascular disease risk in African-American women.

We have previously shown that in Caucasian men and women fat in the trunk, and especially visceral fat, was related to cardiovascular disease (CVD) risk even after adjusting for fat in other depots. We also found that leg fat was negatively related to CVD. In order to determine if these relationships also exist in African-American women, blood lipids, insulin, and blood pressure in 26 pre-menopausal African-American women were evaluated. In addition, magnetic resonance imaging measured fat distribution was evaluated from the lateral malleolus to top of the shoulder. Percent fat was related to VLDL cholesterol, VLDL3 cholesterol, triglycerides, insulin, and diastolic blood pressure. Inclusion of visceral and trunk fat together in multiple regression did little to improve the relationship with CVD risk. Leg fat, however, tended to be negatively related to CVD risk after adjusting for trunk fat and visceral fat. Partial correlations indicated that leg fat was negatively related to VLDL cholesterol (r = -0.36), triglycerides (r = -0.36), insulin (r = -0.46), and diastolic blood pressure (r = -0.43). These results indicate that in African-American women, visceral fat may be less atherogenic than in Caucasian men and women since it was poorly related to CVD risk after adjusting for fat in the trunk. In addition, consistent with results from Caucasians, leg fat is inversely related to CVD risk after adjusting for fat in other parts of the body. Caution must be made in the interpretation of correlational data. Further research is warranted to explore these intriguing relationships.

The effect of leader outcomes on influence, attributions, and perceptions of charisma.

This study addressed how various outcomes to a leader might influence not only how that leader is perceived but also the degree of influence that leader might subsequently obtain. On the basis of recent charismatic leadership theories, it was expected that leaders who appeared willing to endure hardship for the expression of their beliefs would be perceived differently than leaders who appeared to benefit in some way. The relationship between outcomes and subsequent leader influence was confirmed. Sacrificing resulted in greater influence, whereas benefiting reduced it. This relationship was mediated by attributions made about leader motives. The relationship between outcomes and influence was also mediated by perceptions of charisma.

Correlates of alcohol and drug use among low-income Hispanic immigrant childbearing women living in the USA.

Alcohol and drug use is a widespread and serious problem with deleterious consequences for the health and well-being of childbearing-age women and their children. Little information exists regarding etiological factors for substance use among Hispanic childbearing-age women immigrating to the United States (USA). This research provides a correlational analysis of factors associated with alcohol and drug use. The Social Stress Model for Substance Use Prevention provided the conceptual framework for this cross-sectional, interview-administered survey of 60 low-income predominantly Mexican-American women. The outcome variable was alcohol and drug use (alcohol, cigarettes, marijuana, cocaine and opiates). Independent variables included the major constructs of the model: stress, social support, social influences, personal competencies and community resource utilization patterns. Findings suggested that the levels of drug use were lower among this study sample than in the general USA population regardless of pregnancy status. Bivariate correlations demonstrate that women with higher drug use indices had more lenient attitudes regarding drug use and were more likely to have family and friends that used alcohol and drugs. Although drug use was relatively low among this sample of women, both women who used alcohol themselves and women whose partners used alcohol and drugs reported significantly higher levels of stress, weaker social support and poorer levels of self esteem. Implications for practice and future research are suggested.

Competence and drug use: theoretical frameworks, empirical evidence and measurement.

Statistics show that use of harmful substances (alcohol, cigarettes, marijuana, cocaine) among women of childbearing age is widespread and serious. Numerous theoretical models and empirical studies have attempted to explain the complex factors that lead individuals to use drugs. The Social Stress Model of Substance Abuse [1] is one model developed to explain parameters that influence drug use. According to the model, the likelihood of an individual engaging in drug use is seen as a function of the stress level and the extent to which it is offset by stress modifiers such as social networks, social competencies, and resources. The variables of the denominator are viewed as interacting with each other to buffer the impact of stress [1]. This article focuses on one of the constructs in this model: that of competence. It presents a summary of theoretical and conceptual formulations for the construct of competence, a review of empirical evidence for the association of competence with drug use, and describes the preliminary development of a multi-scale instrument designed to assess drug protective competence among low-income Hispanic childbearing women. Based upon theoretical and empirical studies, eight domains of drug protective competence were identified and conceptually defined. Using subscales from existing instruments with psychometric evidence for their validity and reliability, a multi-scale instrument was developed to assess drug protective competence. Hypothesis testing was used to assess construct validity. Four drug protective competence domains (social influence, sociability, self-worth, and control/responsibility) were found to be statistically associated with drug use behaviors. Although not statistically significant, expected trends were observed between drug use and the other four domains of drug protective competence (intimacy, nurturance, goal directedness, and spiritual directedness). Study limitations and suggestions for further psychometric testing of the instrument are described.

First stage labor management: An examination of patterned breathing and fatigue.

BACKGROUND: Patterned breathing is one way that women cope with labor. Fatigue is a frequently reported symptom over which women and caregivers have little control. The purpose of this study was to examine the relationship between the use of patterned breathing, a traditional intervention, and the level of fatigue reported during the first stage of labor. METHOD: A secondary analysis was conducted on a subset (n = 56) of a prospective longitudinal study of fatigue during the intrapartum period. The sample comprised primiparous women in labor whose fatigue was measured every two hours for six hours after admission. At each data point the investigator evaluated the method of breathing that participants used. RESULTS: During the latent phase of labor, women using patterned breathing exhibited significantly more fatigue. In the active phase, differences between groups were not significant. Controlling for age, education, and marital status of participants did not change the results. CONCLUSIONS: It is appropriate for nurses, midwives, physicians, and doulas to encourage the use of patterned breathing as an intervention in active labor; however, patterned breathing may increase the mother's fatigue level if begun too early.

Challenges in measuring patient outcomes.

Reliable and valid measurement of outcomes is a key criterion for assessing the efficacy and effectiveness of nursing interventions. However, measurement in outcomes studies present a special challenge due to the longitudinal nature of such studies as well as the need to operationalize the intervention, specify and select the most relevant contextual and outcome variables, and delineate the influence of other providers on outcomes. This article specifies measurement-related issues and problems that threaten the credibility of outcome studies. Client-related and instrument-related measurement issues which could compromise outcomes measurement are also addressed.