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Watson B, Civen R, Reynolds M, Heath K, Perella D, Carbajal T, Mascola L, Jumaan A, Zimmerman L, James A, Quashi C, Schmid S. Validity of self-reported varicella disease history in pregnant women attending prenatal clinics. Public Health Rep 2007; 122:499-506. [PMID: 17639653 PMCID: PMC1888500 DOI: 10.1177/003335490712200411] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the validity of self-reported history for varicella disease relative to serological evidence of varicella immunity in pregnant women attending antenatal care at clinics located in two diverse geographical locations in the U.S. (Antelope Valley, California, and Philadelphia) with high varicella vaccination coverage. METHODS Pregnant women attending prenatal care appointments who needed blood drawn as part of their routine care were eligible to participate. Self-reported varicella disease history was obtained via questionnaire. Varicella serostatus was determined using a whole-cell enzyme-linked immunosorbent assay to test for varicella zoster virus-specific immunoglobulin G (VZV IgG) antibodies. RESULTS Of the 309 study participants from Antelope Valley and the 528 participants from Philadelphia who self-reported having had chickenpox disease, 308 (99.7%; 95% confidence interval [CI]: 98.2, 100) and 517 (97.9%; 95% CI: 96.3, 99.0), respectively, had serological evidence of immunity to varicella. Only 6.8% (95% CI: 3.9, 11.0) and 17.4% (95% CI: 13.1, 22.5) of women who self-reported having a negative or uncertain varicella disease history in Antelope Valley and Philadelphia, respectively, were seronegative for varicella antibodies. CONCLUSION Despite the dramatic changes in the epidemiology of varicella that have occurred since 1995 due to the introduction and subsequent widespread use of the varicella vaccine, self-reported history of varicella continues to be a strong predictor of VZV IgG antibodies in pregnant women. Negative or uncertain history remains poorly predictive of negative serostatus.
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Zimmerman L. Unraveling the stressful effects of day-to-day life. BEGINNINGS (AMERICAN HOLISTIC NURSES' ASSOCIATION) 2007; 27:12. [PMID: 17381028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Reef SE, Redd SB, Abernathy E, Zimmerman L, Icenogle JP. The epidemiological profile of rubella and congenital rubella syndrome in the United States, 1998-2004: the evidence for absence of endemic transmission. Clin Infect Dis 2006; 43 Suppl 3:S126-32. [PMID: 16998771 DOI: 10.1086/505944] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In 1969, the United States established its national rubella vaccination program. With the success of the program, 32 years later, reports of rubella reached record low numbers. To assess the achievement of elimination of rubella and congenital rubella syndrome (CRS) in the United States, 7 epidemiological criteria were used. Rubella cases reported to the National Notifiable Diseases Surveillance System from 1998 through 2004 and CRS cases reported to the National Congenital Rubella Syndrome Registry from 1998 through 2004 were analyzed. During 1998-2000, the median number of reported rubella cases was 272, whereas, during 2001-2004, the median number reported was 13. The incidence of rubella decreased significantly, from 0.1/100,000 population in 1998 to 0.005/100,000 population in 2004. Since 2001, 5 infants with CRS have been reported--3 were born in 2001, 1 was born in 2003, and 1 was born in 2004. The epidemiological evidence strongly supports the claim that rubella is no longer endemic in the United States. To prevent future rubella outbreaks and CRS cases, current strategies must be maintained.
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Lopez AS, Guris D, Zimmerman L, Gladden L, Moore T, Haselow DT, Loparev VN, Schmid DS, Jumaan AO, Snow SL. One dose of varicella vaccine does not prevent school outbreaks: is it time for a second dose? Pediatrics 2006; 117:e1070-7. [PMID: 16740809 DOI: 10.1542/peds.2005-2085] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The implementation of a routine childhood varicella vaccination program in the United States in 1995 has resulted in a dramatic decline in varicella morbidity and mortality. Although disease incidence has decreased, outbreaks of varicella continue to be reported, increasingly in highly vaccinated populations. In 2000, a varicella vaccination requirement was introduced for kindergarten entry in Arkansas. In October 2003, large numbers of varicella cases were reported in a school with high vaccination coverage. We investigated this outbreak to examine transmission patterns of varicella in this highly vaccinated population, to estimate the effectiveness of 1 dose of varicella vaccine, to identify risk factors for vaccine failure, and to implement outbreak control measures. METHODS A retrospective cohort study involving students attending an elementary school was conducted. A questionnaire was distributed to parents of all of the students in the school to collect varicella disease and vaccination history; parents of varicella case patients were interviewed by telephone. A case of varicella was defined as an acute, generalized, maculopapulovesicular rash without other apparent cause in a student or staff member in the school from September 1 to November 20, 2003. Varicella among vaccinated persons was defined as varicella-like rash that developed >42 days after vaccination. In vaccinated persons, the rash may be atypical, maculopapular with few or no vesicles. Cases were laboratory confirmed by polymerase chain reaction, and genotyping was performed to identify the strain associated with the outbreak. RESULTS Of the 545 students who attended the school, 88% returned the questionnaire. Overall varicella vaccination coverage was 96%. Forty-nine varicella cases were identified; 43 were vaccinated. Three of 6 specimens tested were positive by polymerase chain reaction. The median age at vaccination of vaccinated students in the school was 18 months, and the median time since vaccination was 59 months. Forty-four cases occurred in the East Wing, where 275 students in grades kindergarten through 2 were located, and vaccination coverage was 99%. In this wing, varicella attack rates among unvaccinated and vaccinated students were 100% and 18%, respectively. Vaccine effectiveness against varicella of any severity was 82% and 97% for moderate/severe varicella. Vaccinated cases were significantly milder compared with unvaccinated cases. Among the case patients in the East Wing, the median age at vaccination was 18.5 and 14 months among non-case patients. Four cases in the West Wing did not result in further transmission in that wing. The Arkansas strains were the same as the common varicella-zoster virus strain circulating in the United States (European varicella-zoster virus strain). CONCLUSIONS Although disease was mostly mild, the outbreak lasted for approximately 2 months, suggesting that varicella in vaccinated persons was contagious and that 99% varicella vaccination coverage was not sufficient to prevent the outbreak. This investigation highlights several challenges related to the prevention and control of varicella outbreaks with the 1-dose varicella vaccination program and the need for further prevention of varicella through improved vaccine-induced immunity with a routine 2-dose vaccination program. The challenges include: 1-dose varicella vaccination not providing sufficient herd immunity levels to prevent outbreaks in school settings where exposure can be intense, the effective transmission of varicella among vaccinated children, and the difficulty in the diagnosis of mild cases in vaccinated persons and early recognition of outbreaks for implementing control measures. The efficacy of 2 doses of varicella vaccine compared with 1 dose was assessed in a trial conducted among healthy children who were followed for 10 years. The efficacy for 2 doses was significantly higher than for 1 dose of varicella vaccine. This higher efficacy translated into a 3.3-fold lower risk of developing varicella >42 days after vaccination in 2- vs 1-dose recipients. Of the children receiving 2 doses, 99% achieved a glycoprotein-based enzyme-linked immunosorbent assay level of > or =5 units (considered a correlate of protection) 6 weeks after vaccination compared with 86% of children who received 1 dose. The 6-week glycoprotein-based enzyme-linked immunosorbent assay level of > or =5 units has been shown to be a good surrogate for protection from natural disease. Ten years after the implementation of the varicella vaccination program, disease incidence has declined dramatically, and vaccination coverage has increased greatly. However, varicella outbreaks continue to occur among vaccinated persons. Although varicella disease among vaccinated persons is mild, they are contagious and able to sustain transmission. As a step toward better control of varicella outbreaks and to reduce the impact on schools and public health officials, in June 2005, the Advisory Committee on Immunization Practices recommended the use of a second dose of varicella vaccine in outbreak settings. Early recognition of outbreaks is important to effectively implement a 2-dose vaccination response and to prevent more cases. Although the current recommendation of providing a second dose of varicella vaccine during an outbreak offers a tool for controlling outbreaks, a routine 2-dose recommendation would be more effective at preventing cases. Based on published data on immunogenicity and efficacy of 2 doses of varicella vaccine, routine 2-dose vaccination will provide improved protection against disease and further reduce morbidity and mortality from varicella.
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Yonas A, Zimmerman L, Seo H, Alexander AJ, Olinick AS, Polley SZ. The effect of luminance contrast and stroboscopic presentation on the threshold for the discrimination of approach from withdrawl. J Vis 2005. [DOI: 10.1167/5.8.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Zhou F, Reef S, Massoudi M, Papania MJ, Yusuf HR, Bardenheier B, Zimmerman L, McCauley MM. An Economic Analysis of the Current Universal 2-dose measles-mumps-rubella Vaccination Program in the United States. J Infect Dis 2004; 189 Suppl 1:S131-45. [PMID: 15106102 DOI: 10.1086/378987] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
To evaluate the economic impact of the current 2-dose measles-mumps-rubella (MMR) vaccination program in the United States, a decision tree-based analysis was conducted with population-based vaccination coverage and disease incidence data. All costs were estimated for a hypothetical US birth cohort of 3803295 infants born in 2001. The 2-dose MMR vaccination program was cost-saving from both the direct cost and societal perspectives compared with the absence of MMR vaccination, with net savings (net present value) from the direct cost and societal perspectives of US dollars 3.5 billion and US dollars 7.6 billion, respectively. The direct and societal benefit-cost ratios for the MMR vaccination program were 14.2 and 26.0. Analysis of the incremental benefit-cost of the second dose showed that direct and societal benefit-cost ratios were 0.31 and 0.49, respectively. Varying the proportion of vaccines purchased and administered in the public versus the private sector had little effect on the results. From both perspectives under even the most conservative assumptions, the national 2-dose MMR vaccination program is highly cost-beneficial and results in substantial cost savings.
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Dayan GH, Zimmerman L, Shteinke L, Kasymbekova K, Uzicanin A, Strebel P, Reef S. Investigation of a rubella outbreak in Kyrgyzstan in 2001: implications for an integrated approach to measles elimination and prevention of congenital rubella syndrome. J Infect Dis 2003; 187 Suppl 1:S235-40. [PMID: 12721919 DOI: 10.1086/368037] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In 1999, the Ministry of Health of Kyrgyzstan adopted the goal of measles elimination. This opportunity was used to launch a rubella and congenital rubella syndrome prevention program. Between January and August 2001, a rubella outbreak occurred in Bishkek City and Chui Oblast. Rubella surveillance data were reviewed for Kyrgyzstan (1981-2000) and rubella case-patient and laboratory information from Bishkek City and Chui Oblast during the outbreak. The data suggest that rubella is endemic in Kyrgyzstan with periodic epidemics every 3-5 years. From January to August 2001, 1936 rubella case-patients were reported from Bishkek City and Chui Oblast; 242 were tested and 176 (73%) were laboratory confirmed. Most case-patients were 3-14 years old. However, the incidence rate per 100,000 among persons aged 15-35 years increased >/=40-fold from 1 in 2000 to 41 in 2001. These findings highlight the importance of introducing rubella-containing vaccine in conjunction with measles elimination activities.
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Zimmerman L, Fajardo M, Seward J, Ludwig S, Johnson J, Wharton M. Varicella susceptibility and validity of history among U.S. Coast Guard recruits: an outbreak-based study. Mil Med 2003; 168:404-7. [PMID: 12775178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
During a varicella outbreak among U.S. Coast Guard recruits, we examined varicella susceptibility serologically and evaluated validity of disease history. Recruits completed a questionnaire to obtain information on demographics, history of varicella disease, and varicella vaccination. Serological testing for varicella-zoster virus immunoglobulin G antibodies was conducted using an enzyme-linked immunosorbant assay. Among 513 recruits, 21 (4.1%) were seronegative to varicella-zoster virus. Recruits born in Puerto Rico were more likely than recruits born in the U.S. states to be susceptible (prevalence ratio, 4.3; 95% confidence interval, 1.4%, 13.1%). A positive disease history was highly predictive of positive serology (99.1%); however, 73% of those with a negative or uncertain history were also immune. Four (19%) susceptible recruits reported a positive varicella history. Although immunity among recruits was high, varicella outbreaks may occur in closed adult settings due to the high risks of exposure and transmission. Varicella vaccination can prevent these costly, disruptive outbreaks.
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Zimmerman L, Fajardo M, Seward J, Ludwig S, Johnson J, Wharton M. Varicella Susceptibility and Validity of History among U.S. Coast Guard Recruits: An Outbreak-Based Study. Mil Med 2003. [DOI: 10.1093/milmed/168.5.404] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Danovaro-Holliday MC, Zimmerman L, Reef SE. Preventing congenital rubella syndrome (CRS) through vaccination of susceptible women of childbearing age. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2001; 10:617-9. [PMID: 11571090 DOI: 10.1089/15246090152563489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zimmerman L, Reef SE. Incidence of congenital rubella syndrome at a hospital serving a predominantly Hispanic population, El Paso, Texas. Pediatrics 2001; 107:E40. [PMID: 11230621 DOI: 10.1542/peds.107.3.e40] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The current epidemiology of rubella reveals an increase in the number of cases among adult Hispanics and an increase in the number of congenital rubella syndrome (CRS) cases among infants of Hispanic mothers. Recent rubella outbreaks have occurred primarily among adult Hispanics, many of whom are foreign-born natives of countries where rubella vaccination is not routine or has only recently been implemented. The objective of this study was to estimate the incidence of CRS in a hospital serving a predominantly Hispanic population. METHODS Hospital charts of infants <1 year old discharged between January 1, 1994 and December 31, 1996 with International Classification of Diseases, Ninth Revision (ICD-9) discharge codes consistent with CRS were reviewed; we looked for cataracts, deafness, congenital heart defects, dermal erythropoiesis, microcephaly, meningoencephalitis, and other defects associated with CRS. We abstracted data on maternal and infant ethnicity, maternal age, gestational age, infants' birth weight, infants' clinical characteristics, and laboratory evaluation. Cases were categorized according to the Council of State and Territorial Epidemiologists' case classification for CRS. RESULTS Of the 182 infants with 1 or more ICD-9 codes consistent with CRS, 6 (3.3%) met either the confirmed or probable case definition for CRS. Two infants met the definition for confirmed CRS. Although laboratory tests for rubella immunoglobulin M antibodies were positive for both of these infants, only 1 of the cases had been reported to the state health department. Four other infants had clinical presentations that met the definition for a probable case. One of these had been tested for rubella immunoglobulin M antibodies, and the test was negative. The other 3 had not been tested. The rate of infants meeting the definition of confirmed and probable CRS was 3.1 per 10 000 hospital births. All confirmed and probable cases were among infants born to Hispanic mothers. Maternal country of origin was Mexico for the 2 confirmed cases and 1 of the probable cases, and unknown for the remaining 3 probable cases. CONCLUSION The rate of confirmed and probable CRS among infants in this predominantly Hispanic population is higher than the reported rate in the United States in the vaccine era, which has been reported to range from approximately 0.01-0.08 per 10 000 live births. These findings indicate a need for heightened awareness of CRS among physicians who serve populations at risk for rubella. Physicians should report all confirmed and probable CRS cases to the state health department. The lack of appropriate laboratory testing in 3 infants with probable CRS indicates that physicians should consider a diagnosis of CRS in infants with some signs consistent with CRS, particularly in areas serving high numbers of individuals at risk for rubella.
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Neely MD, Zimmerman L, Picklo MJ, Ou JJ, Morales CR, Montine KS, Amaranth V, Montine TJ. Congeners of N(alpha)-acetyl-L-cysteine but not aminoguanidine act as neuroprotectants from the lipid peroxidation product 4-hydroxy-2-nonenal. Free Radic Biol Med 2000; 29:1028-36. [PMID: 11084291 DOI: 10.1016/s0891-5849(00)00411-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Increased generation of neurotoxic lipid peroxidation products is proposed to contribute to the pathogenesis of Alzheimer's disease (AD). Current antioxidant therapies are directed at limiting propagation of brain lipid peroxidation. Another approach would be to scavenge the reactive aldehyde products of lipid peroxidation. N(alpha)-acetyl-L-cysteine (NAC) and aminoguanidine (AG) react rapidly and irreversibly with 4-hydroxy-2-nonenal (HNE) in vitro, and both have been proposed as potential scavengers of HNE in biological systems. We have compared NAC, AG, and a series of congeners as scavengers of HNE and as neuroprotectants from HNE. Our results showed that while both NAC and AG had comparable chemical reactivity with HNE, only NAC and its congeners were able to block HNE-protein adduct formation in vitro and in neuronal cultures. Moreover, NAC and its congeners, but not AG, effectively protected brain mitochondrial respiration and neuronal microtubule structure from the toxic effects of HNE. We conclude that NAC and its congeners, but not AG, may act as neuroprotectants from HNE.
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Zimmerman L, Mitchell B, Wister A, Gutman G. Unanticipated consequences: a comparison of expected and actual retirement timing among older women. J Women Aging 2000; 12:109-28. [PMID: 10986854 DOI: 10.1300/j074v12n01_08] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The present study adds to the growing body of literature on women and retirement by means of a comparative analysis of the factors associated with anticipated retirement timing (among pre-retirees) and actual retirement timing (among retirees). Adopting a political economy of aging perspective, we argue that socially-structured patterns of gender inequality related to women's multiple roles across the life course affect patterns of retirement timing. Specifically, we hypothesize that the gendered nature of women's work-retirement decision-making is unanticipated during pre-retirement years. Logistic regression analyses are performed on data drawn from a sample of 275 women aged 45 and older living in the Vancouver area of British Columbia. A central finding is that while actual timing of retirement is affected by family caregiving responsibilities and by health/stress factors, pre-retirees do not perceive these to be important in their own expected retirement timing. Implications for social policy, education, and women's financial and psychological well-being in old age are elaborated.
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Barnason S, Zimmerman L, Anderson A, Mohr-Burt S, Nieveen J. Functional status outcomes of patients with a coronary artery bypass graft over time. Heart Lung 2000; 29:33-46. [PMID: 10636955 DOI: 10.1016/s0147-9563(00)90035-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine functional status outcomes among patients with a coronary artery bypass graft (CABG) over time (ie, at baseline; 3 months, 6 months, and 12 months after surgery) and the impact of selected patient characteristics (ie, age, sex, comorbidities, and cardiac rehabilitation participation) on functional outcomes. DESIGN A prospective, repeated-measures design was used to examine functional status in patients with a CABG over time. SETTING A midwestern community hospital and regional cardiac referral center was the setting for enrolling patients with a CABG. OUTCOME MEASURES Functional status outcomes were measured by using the Medical Outcomes Study (MOS) Short Form 36 (SF-36) and Modified 7-Day Activity instruments. METHODS Baseline data were obtained by patient interview in the hospital setting after CABG surgery. At 3 months, 6 months, and 12 months after surgery, telephone interviews were conducted to administer research instruments. RESULTS Baseline scores on 7 of the 8 subscales of the MOS SF-36 were significantly lower than at 3 months, 6 months, or 12 months after surgery. Role-emotional functioning baseline scores were not significantly lower than 3-month scores; however, baseline scores were significantly lower than 6-month and 12-month scores. Three-month subscale scores were also significantly lower than 6-month or 12-month scores except for the subscales measuring social and general health functioning. Functional status as measured by the Modified 7-Day Activity tool did not demonstrate any significant differences between 3-month, 6-month, or 12-month activity levels. There were no significant differences by age group on any of the 8 subscales of the MOS SF-36 instrument. Women and subjects with more than 1 comorbidity had a significantly lower preoperative level of physical functioning. Cardiac rehabilitation participants had lower preoperative scores on role-emotional functioning than subjects who were not in rehabilitation. CONCLUSION Findings from this study can assist nurses and other health care workers to gain a perspective of the recovery and rehabilitation trajectory of patients with a CABG. The results of the study provide a basis for determining areas of functional limitations during recovery from CABG surgery. Study results can also be the foundation for evaluating outcomes of patients with a CABG when specific interventions (eg, pain management, psychosocial support, physical strengthening, fatigue management) are implemented during hospitalization, home recovery, and rehabilitation to target optimal psychosocial and physiologic functioning of patients with a CABG.
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Zimmerman L, Buckenmeyer C. Y2 worry. It's not too late to prepare for year 2000 computer problems. JEMS : A JOURNAL OF EMERGENCY MEDICAL SERVICES 1999; 24:56-8, 60-2, 64-5. [PMID: 10538560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Mason WA, Zimmerman L, Evans W. Sexual and physical abuse among incarcerated youth: implications for sexual behavior, contraceptive use, and teenage pregnancy. CHILD ABUSE & NEGLECT 1998; 22:987-95. [PMID: 9793721 DOI: 10.1016/s0145-2134(98)00080-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE In the present study, physical and sexual abuse among incarcerated youth were examined with respect to sexual activity, contraceptive use, and pregnancy. METHOD The self-report survey data were collected from 62 females and 334 males who were incarcerated in Nevada youth correctional facilities in the summer of 1994. Of the males, 46.8% (n = 156) reported a history of physical abuse and 9.9% (n = 33) reported sexual abuse. A surprisingly high 73% (n = 46) of the females reported a history of physical abuse and 68.3% (n = 43) reported sexual abuse. RESULTS The analyses indicated that females who reported a history of sexual abuse had an earlier mean age of first intercourse than those who reported no sexual abuse. In addition, male and female respondents with a history of physical and/or sexual abuse reported using no method of contraception as compared to youth with no history of abuse. CONCLUSIONS Implications of these results for detention-based counseling and prevention programming are discussed.
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Nelson FV, Zimmerman L, Barnason S, Nieveen J, Schmaderer M. The relationship and influence of anxiety on postoperative pain in the coronary artery bypass graft patient. J Pain Symptom Manage 1998; 15:102-9. [PMID: 9494308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purposes of this study were to investigate the relationship of postoperative anxiety and pain following coronary artery bypass graft (CABG) surgery, and to determine the effects of level of anxiety, demographic, and other factors on the level of postoperative pain. Pain intensity, sensory pain, and affective pain were measured along with anxiety on postoperative day 2 and day 3 by the McGill Pain Questionnaire Subscales (PPI, PRIS, and PRIA) and State Anxiety Inventory Scale, respectively. A direct relationship of anxiety with pain was found over time with the highest relationship on postoperative day 2 (r = 0.235-0.492, P < 0.001). A significant interaction between time and level of anxiety on affective pain was specific to postoperative day 2 (P < 0.01). Significant differences by level of anxiety and time were reported. Factors of age, gender, marital status, number of previous surgeries, and operation time had no effect on the level of postoperative pain.
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Bissell RA, Eslinger DG, Zimmerman L. The efficacy of advanced life support: a review of the literature. Prehosp Disaster Med 1998; 13:77-87. [PMID: 10187031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Jurisdictions throughout the United States and some other parts of the world have invested substantial time and resources into creating and sustaining a prehospital advanced life support (ALS) system without knowing whether the efficacy of ALS-level care had been validated scientifically. In recent years, it has become fashionable for speakers before large audiences to declare that there is no scientific evidence for the clinical effectiveness of ALS-level care in the out-of-hospital setting. This study was undertaken to evaluate the evidence that pertains to the efficacy of ALS-level care in the current scientific literature. METHODS An extensive review of the available literature was accomplished using computerized and manual means to identify all applicable articles from 1966 to October, 1995. Selected articles were read, abstracted, analyzed, and compiled. Each article also was categorized as presenting evidence supporting or refuting the clinical efficacy of ALS-level care, and a list was constructed that pointed to where the preponderance of the evidence lies. RESULTS Research in this field differs widely in terms of methodological sophistication. Of the 51 articles reviewed, eight concluded that ALS-level care is not any more effective than is basic life support, seven concluded that it is effective in some applications but not for others, and the remainder demonstrated effectiveness. The strongest support for ALS-level care was in the area of responses to victims of cardiac arrest, whereas somewhat more divergent findings related to trauma or non condition-specific studies. CONCLUSIONS While not unanimous, the predominant finding of recent research into the clinical effectiveness of advanced life support demonstrates improved effectiveness over basic life support for patients with certain pathologies. More outcomes-based research is needed.
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Zimmerman L. Respiratory therapist-driven protocols. West J Med 1997; 167:440-1. [PMID: 9426490 PMCID: PMC1304731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Zimmerman L. Eleanor walled herself in. Nursing 1997; 27:42-44. [PMID: 9205296 DOI: 10.1097/00152193-199706000-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Crutchfield J, Zimmerman L, Nieveen J, Barnason S, Pozehl B. Preoperative and postoperative pain in total knee replacement patients. Orthop Nurs 1996; 15:65-72. [PMID: 8788613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This descriptive study examined pain descriptors in a group of patients with arthritis prior to total knee replacement (TKR), and on postoperative days 1 and 3. The McGill Pain Questionnaire (MPQ), consisting of 78 descriptive words in 20 subclasses of descriptors scaled on intensity dimensions, was administered to each subject prior to and on two occasions after surgery. The findings support results from previous studies indicating that clusters of words are more often selected to express chronic pain, and other patterns are used to describe acute pain during the early postoperative period. Also, subjects experienced considerable pain intensity related to arthritis prior to surgery, and they reported less overall pain intensity following their TKR.
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Abstract
Pain can cause both physical and psychological distress that has a negative impact on a patient's quality of life. The purpose of this descriptive study was to determine whether cancer patients (N = 60) with pain (n = 30) had higher scores of depression, anxiety, somatization, and hostility than did cancer patients without pain (n = 30). The study was conducted in a midwestern medical center hospital during a 9-month period. Psychological variables were measured using subscales of the Brief Symptom Inventory (BSI). Patients who reported pain completed the McGill Pain Questionnaire (MPQ) and Visual Analogue Scale. Significant positive correlations were found between total MPQ scores and all four subscales of the BSI (r = 0.60-0.78, p < 0.05). Patients with pain scored higher on all four subscales of the BSI, with significant differences occurring in somatization (t = 2.05, p < 0.05) and hostility (t = 1.93, p < 0.05). The findings suggest a relationship between pain intensity and psychological status. Nursing interventions aimed at reducing these factors may help to decrease the pain, in addition to then decreasing the psychological distress experienced by patients with cancer.
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48
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Pozehl B, Barnason S, Zimmerman L, Nieveen J, Crutchfield J. Pain in the postoperative coronary artery bypass graft patient. Clin Nurs Res 1995; 4:208-22. [PMID: 7757027 DOI: 10.1177/105477389500400207] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The purpose of this study was to assess and describe the multidimensional postoperative pain experience of patients (N = 194) undergoing coronary artery bypass graft surgery (CABG) using the McGill Pain Questionnaire. Postoperative pain significantly decreased from postoperative day 2 to postoperative day 3 for all components of the McGill Pain Questionnaire. Sensory words chosen from the McGill Pain Questionnaire on postoperative day 2 included sharp, sore, aching, and tender. Affective words chosen included exhausting on postoperative day 2 and tiring on postoperative days 2 and 3. The evaluative word annoying was chosen for both postoperative days 2 and 3. The present pain intensity (PPI) rating completed on a scale from no pain = 0 to excruciating pain = 5, showed a mean intensity rating of 1.08 for postoperative day 2 and 0.67 for postoperative day 3. These findings describing the typical pattern of postoperative pain are clinically significant in the differentiation of "normal" postoperative pain from pain experienced with postoperative complications from CABG surgery.
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Barnason S, Zimmerman L, Nieveen J. The effects of music interventions on anxiety in the patient after coronary artery bypass grafting. Heart Lung 1995; 24:124-32. [PMID: 7759273 DOI: 10.1016/s0147-9563(05)80007-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the influence during the early postoperative period of selected nursing interventions on mood and anxiety of patients undergoing heart surgery. DESIGN Prospective, repeated measures, quasiexperimental, random assignment. SETTING The cardiovascular intensive care and progressive care units of a midwestern community hospital were used as the setting for this study. PATIENTS Ninety-six patients who underwent elective, heart bypass surgery; the mean age of the subjects was 67 years, with an age range of 37 to 84 years. Most subjects were men (n = 65, 68%). OUTCOME MEASURES Physiologic measures of anxiety and mood include blood pressure and heart rate. Additional measures included the use of Spielberger's state-trait anxiety inventory (STAI) and patient verbal ratings of both mood and anxiety with use of a numeric rating scale (NRS). INTERVENTION Patients were randomly assigned to one of three groups: (1) music therapy, (2) music-video therapy, or (3) scheduled rest group. Subjects in the groups received their assigned 30-minute intervention at two episodes on postoperative days 2 and 3. Subjects had physiologic measures of blood pressure and heart rate measured immediately before the intervention and at 10-minute intervals throughout the intervention. Mood and anxiety were evaluated by having subjects use a NRS (i.e., 0 to 10) to give rating of mood and anxiety immediately before and after each session. Anxiety was further measured with the STAI. A baseline measure of STAI was taken before surgery; patients also completed the "state" anxiety tool before the intervention session on postoperative day 2 and on completion of the session on postoperative day 3. RESULTS With use of an analysis of covariance (ANCOVA), subjects' mood ratings showed significant improvement in mood among subjects in the "music intervention" group after the second intervention when controlling for the preintervention rating of mood, F(2, 87) = 4.33, p = 0.016. However, no significant differences were reported for anxiety ratings as measured by the NRS and state anxiety instruments. With use of repeated measures analysis of variance (ANOVA), there were no significant interactions between the intervention groups and time for any of the physiologic variables. However, there were significant main effects over time for heart rate and systolic and diastolic blood pressure, which indicated a generalized physiologic relaxation response. CONCLUSIONS Although none of the three interventions was overwhelmingly superior, the overall response by all intervention groups demonstrated a generalized relaxation response. It is also important to note that there was reduced anxiety and improved mood within all three groups.
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Zimmerman L, McDonald L. Emotional availability in infants' relationships with multiple caregivers. AMERICAN JOURNAL OF ORTHOPSYCHIATRY 1995; 65:147-52. [PMID: 7733210 DOI: 10.1037/h0079586] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Emotional availability was rated in infants' relationships with significant caregivers over a nine-month period. Infant responsivity to and involvement of caregivers was found to be related to individual sensitivity, while each relationship appeared to be unique, and not based on the nature of the infants' relationships with their mothers.
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