"She looked just like me." A domestic violence learning module

This paper describes a 22-hour domestic violence learning module that is incorporated into the psychosocial course for seniors in a baccalaureate nursing program. As part of their learning experiences, students attend circuit court, meet with judges, and accompany advocacy workers. Additionally, they attend group therapy sessions with both the victims and perpetrators of abuse. Students keep journals reflecting their thoughts, feelings, and reactions throughout the experiences. Thematic analysis of these journal entries revealed five common themes. Students recognized their encounters in clinical situations as frightening and emotionally difficult, expressed surprise at their reactions to perpetrators, identified with victims, wrestled with issues of good and bad, and reported that stereotypes about victims and perpetrators had been incorrect. Debriefings and support by faculty are important for students throughout the experience.

Acoustic shadowing on B-mode ultrasound of the carotid artery predicts ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) study

BACKGROUND AND PURPOSE

We examined the relationship of carotid artery lesions (CALs), with and without acoustic shadowing (AS), to incident ischemic stroke events in the Atherosclerosis Risk in Communities study cohort.

METHODS

The study population consisted of 13 123 men and women aged 45 to 64 years, and free of stroke, examined during 1986-1989. Over an average follow-up time of 8.0 years, 226 incident ischemic stroke cases (thromboembolic brain infarctions) were identified and classified by a standardized protocol. Three levels of exposure were defined on the basis of the presence of B-mode ultrasound-detected CALs and AS in a 3-cm segment of the carotid arteries centered at the bifurcation.

RESULTS

The hazard ratio for ischemic stroke adjusted for age, ethnicity, and study site for women with a CAL without AS, compared with those without a CAL, was 1.92 (95% CI, 1.23, 3.01), and the hazard ratio comparing those with a CAL with AS with those without a CAL was 4.01 (95% CI, 2.28, 7.06). The corresponding hazard ratios for men were 1.99 (95% CI, 1.36, 2.91) and 2.23 (95% CI, 1.32, 3.79). Although adjustment for diabetes, hypertension medication, systolic blood pressure, left ventricular hypertrophy score, fibrinogen, von Willebrand factor antigen, and smoking status attenuated these associations somewhat, when compared with no evidence of CALs, CALs with AS remained statistically significant predictors of ischemic stroke in women, while CALs without AS were predictive of ischemic stroke in men.

CONCLUSIONS

B-mode ultrasound-detected CALs and AS serve as markers of atherosclerosis and thus are predictive of ischemic stroke.

Community noise exposure and stress in children

Although accumulating evidence over the past two decades points towards noise as an ambient stressor for children, all of the data emanate from studies in high-intensity, noise impact zones around airports or major roads. Extremely little is known about the nonauditory consequences of typical, day-to-day noise exposure among young children. The present study examined multimethodological indices of stress among children living under 50 dB or above 60 dB (A-weighted, day-night average sound levels) in small towns and villages in Austria. The major noise sources were local road and rail traffic. The two samples were comparable in parental education, housing characteristics, family size, marital status, and body mass index, and index of body fat. All of the children were prescreened for normal hearing acuity. Children in the noisier areas had elevated resting systolic blood pressure and 8-h, overnight urinary cortisol. The children from noisier neighborhoods also evidenced elevated heart rate reactivity to a discrete stressor (reading test) in the laboratory and rated themselves higher in perceived stress symptoms on a standardized index. Furthermore girls, but not boys, evidenced diminished motivation in a standardized behavioral protocol. All data except for the overnight urinary neuroendocrine indices were collected in the laboratory. The results are discussed in the context of prior airport noise and nonauditory health studies. More behavioral and health research is needed on children with typical, day-to-day noise exposure.

Acoustic shadowing on B-mode ultrasound of the carotid artery predicts CHD

The relationship between carotid artery lesions (CALs), with and without acoustic shadowing (AS) as an index of arterial mineralization, and incident coronary heart disease (CHD) was examined in the Atherosclerosis Risk in Communities study cohort. Among 12,375 individuals, ages 45-64 years, free of CHD at baseline, 399 CHD events occurred between 1987-1995. In a 3-cm segment centered at the carotid bifurcation, CALs with and without AS were identified by B-mode ultrasound (US). After adjustment for the major CHD risk factors, the CHD hazard ratio (HR) for women with CAL without AS compared to women without CAL was 1.78 (95% CI: 1.22, 2.60) and the HR comparing women with CAL with AS to women with CAL without AS was 1.73 (95% CI: 1.07, 2.80). Corresponding HRs for men were 1.59 (95% CI: 1.22, 2.07) and 1.04 (95% CI: 0.72, 1.51). CALs predicted CHD events; this association was stronger for mineralized CALs in women, but not men.

Cross-cultural differences in tolerance for crowding: fact or fiction?

It is widely believed that cultures vary in their tolerance for crowding. There is, however, little evidence to substantiate this belief, coupled with serious shortcomings in the extant literature. Tolerance for crowding has been confused with cultural differences in personal space preferences along with perceived crowding. Furthermore, the few studies that have examined cultural variability in reactions to crowding have compared subgroup correlations, which is not equivalent to a statistical interaction. Although the authors found a statistical interaction indicating that Asian Americans and Latin Americans differ in the way they perceive crowding in comparison to their fellow Anglo-American and African American citizens, all four ethnic groups suffer similar, negative psychological distress sequelae of high-density housing. These results hold independently of household income.

Stress and open-office noise

Forty female clerical workers were randomly assigned to a control condition or to 3-hr exposure to low-intensity noise designed to simulate typical open-office noise levels. The simulated open-office noise elevated workers' urinary epinephrine levels, but not their norepinephrine or cortisol levels, and it produced behavioral aftereffects (fewer attempts at unsolvable puzzles) indicative of motivational deficits. Participants were also less likely to make ergonomic, postural adjustments in their computer work station while working under noisy, relative to quiet, conditions. Postural invariance is a risk factor for musculoskeletal disorder. Although participants in the noise condition perceived their work setting as significantly noisier than those working under quiet conditions did, the groups did not differ in perceived stress. Potential health consequences of long-term exposure to low-intensity office noise are discussed.

Housing quality and mental health

This study examined the potential link between housing quality and mental health. First, the development of a psychometrically sound, observer-based instrument to assess physical housing quality in ways conceptually relevant to psychological health is reported. Then 2 different studies, including a prospective longitudinal design, demonstrate that physical housing quality predicts mental health. Possible underlying psychosocial processes for the housing quality-psychological distress link are discussed.

Cross-cultural differences in tolerance for crowding: fact or fiction?

It is widely believed that cultures vary in their tolerance for crowding. There is, however, little evidence to substantiate this belief, coupled with serious shortcomings in the extant literature. Tolerance for crowding has been confused with cultural differences in personal space preferences along with perceived crowding. Furthermore, the few studies that have examined cultural variability in reactions to crowding have compared subgroup correlations, which is not equivalent to a statistical interaction. Although the authors found a statistical interaction indicating that Asian Americans and Latin Americans differ in the way they perceive crowding in comparison to their fellow Anglo-American and African American citizens, all four ethnic groups suffer similar, negative psychological distress sequelae of high-density housing. These results hold independently of household income.

Housing quality and mental health

This study examined the potential link between housing quality and mental health. First, the development of a psychometrically sound, observer-based instrument to assess physical housing quality in ways conceptually relevant to psychological health is reported. Then 2 different studies, including a prospective longitudinal design, demonstrate that physical housing quality predicts mental health. Possible underlying psychosocial processes for the housing quality-psychological distress link are discussed.

Hypertension and arterial stiffness: the Atherosclerosis Risk in Communities Study. ARIC Investigators

Our objective was to describe the relationship of arterial stiffness and hypertension in a large, population-based sample of men and women. Hypertension-related increases in arterial stiffness may reflect the distending pressure and/or structural alterations in the artery. Included were 10,712 participants, ages 45 to 64 years, of the Atherosclerosis Risk in Communities Study, free of prevalent cardiovascular disease. Hypertension was classified as systolic or diastolic blood pressure (BP) > or =140/90 mm Hg, respectively, or the current use of antihypertensive medications. Common carotid arterial diameter change was measured using B-mode ultrasound and an electronic device that utilized radio frequency signals to track the motion of the arterial walls. Using statistical models to control for diastolic BP and pulse pressure, arterial diameter change was calculated separately in normotensive/ nonmedicated and medicated hypertensives. Hypertension was associated with a smaller adjusted diameter change (ie, greater stiffness) in comparison to optimal blood pressure (BP < 120/80 mm Hg): normotensive/nonmedicated men, 0.33 versus 0.43 mm (P < 0.001); medicated men, 0.34 versus 0.42 mm (P < 0.001); normotensive/ nonmedicated women, 0.34 versus 0.40 mm (P < 0.001), and medicated women, 0.33 versus 0.40 mm (P < 0.001). The relationship between pulse pressure and diameter change (ie, the slope of pulse pressure and diameter change) did not differ between hypertensives and normotensives. These cross-sectional data suggest that hypertension is associated with carotid arterial stiffness; however, these differences in the calculated stiffness appear to be the effect of distending pressure rather than structural changes in the carotid artery.

The distribution of costs of care in mechanically ventilated patients with chronic obstructive pulmonary disease

OBJECTIVES

To delineate the costs of care of patients with Chronic Obstructive Pulmonary Disease (COPD) and respiratory failure and to compare them with those of other mechanically ventilated patients.

DESIGN

A post hoc analysis of a prospective investigation.

SETTING

Medical and coronary intensive care units (ICUs) of an 804-bed, university-based hospital.

PATIENTS

A total of 300 mechanically ventilated patients, 44 with COPD and 256 others, were included.

MEASUREMENTS AND MAIN RESULTS

Despite similar lengths of ICU stay (9 days) and mechanical ventilation (5.5 days COPD vs. 5 days other, p = .11), ICU respiratory care costs for patients with COPD were $2,422 ($1,157-$6,110) [median U.S. dollars (interquartile range)] vs. $1,580 ($738-$3,322) for the others (p = .01). Ventilator costs for COPD patients were $1,795 ($943-$5,782) vs. $1,574 ($613-$3,112) (p = .12). Total hospitalization respiratory care costs for COPD patients were higher, $4,064 ($2,422-$9,572) vs. $2,342 ($1,186-$4,591), (p = .0001), and 74.4% of the median difference in cost between COPD patients and others was accounted for by spontaneous nebulizers (p = .001), metered dose inhalers (p = .01), and pulse oximetry (p = .02). By using multiple linear regression analyses, we found that COPD remained associated with higher respiratory costs (p<.05). Respiratory Care was the third largest category of hospital costs after beds (27%) and pharmacy expenses (25%), and it comprised approximately 14% of total cost. Total hospital costs were large for both groups, but did not differ between COPD and the others [$24,217 ($16,211-$58,834) vs. $27,672 ($15,692-$53,766), respectively (p = .96)]. Linear regression analyses showed that only Acute Lung Injury score was significantly related to total ICU and hospital costs of care (p<.05).

CONCLUSIONS

Costs of ICU and non-ICU respiratory care for patients with COPD are higher than costs of care for other mechanically ventilated patients. Although the increased cost of bronchodilators and oximetry in these patients may serve as target areas for reductions in respiratory care costs, it may also be true that these modalities of therapy and management are necessary and need to be used with even greater intensity to achieve better outcomes. The predominant contributions of bed and pharmacy costs in all of our patients with respiratory failure support research efforts addressing these aspects of care.

Parental language and verbal responsiveness to children in crowded homes

This article is a secondary data analysis of the University of Kansas Language Acquisition Project, which intensively studied, on a regular basis, parent and child language from age 6 months to 30 months. The association between residential density and parent-child speech was examined. Parents in crowded homes speak in less complex, sophisticated ways with their children compared with parents in uncrowded homes, and this association is mediated by parental responsiveness. Parents in more crowded homes are less verbally responsive to their children. This in turn accounts for their simpler, less sophisticated speech to their children. This mediational pathway is evident with statistical controls for socioeconomic status. This model may help explain prior findings showing a link between residential crowding and delayed cognitive development.

The psychological cost of aircraft noise for children

Psychological effects of aircraft noise exposure on children have only recently been addressed in the References. The current study took advantage of a natural experiment caused by the opening of a major new airport, exposing children in a formerly quiet area to aircraft noise. In this prospective longitudinal investigation, which employed non-exposed control groups, effects of aircraft noise prior to and subsequent to inauguration of the new airport as well as effects of chronic noise and its reduction at the old airport (6 and 18 month post relocation), were studied in 326 children aged 9 to 13 years. The psychological health of children was investigated with a standardized quality of life scale as well as with a motivational measure derived from the Glass and Singer stress aftereffects paradigm. In addition a self report noise annoyance scale was used. In the children studied at the two airports over three time points, results showed a significant decrease of total quality of life 18 month after aircraft noise exposure as well as a motivational deficits operationalized by fewer attempts to solve insoluble puzzles in the new airport area. Parallel shifts in children's attributions for failure were also noted. At the old airport parallel impairments were present before the airport relocation but subsided there after. These findings are in accord with reports of impaired psychological health after noise exposure and indicate the relevance of monitoring psychological parameters as a function of environmental stressors among children.

Effects of lovastatin and warfarin on early carotid atherosclerosis: sex-specific analyses. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group

BACKGROUND

Few clinical trials have documented the efficacy of preventive treatment in asymptomatic women.

METHODS AND RESULTS

Lovastatin and minidose warfarin were evaluated in a factorially designed, placebo-controlled, randomized trial. The primary outcome was 3-year change in the mean maximum intimal-medial thickness of the carotid arteries as measured by B-mode ultrasonography. Participants (n=919) were randomized to 1 of 4 treatment groups: lovastatin alone, warfarin alone, lovastatin+warfarin combination, or a double-placebo group. Eligible participants were asymptomatic for cardiovascular disease, with evidence of early carotid atherosclerosis and moderately elevated LDL cholesterol level. Almost half (n=445) of the participants were women. To avoid confounding, 117 women taking estrogen were excluded from analysis. Both sexes experienced reductions in disease progression with lovastatin; there was no evidence of an overall sex x treatment interaction (P=0.72). When estimates of the sex-specific results were examined post hoc, women experienced disease regression to the greatest extent with the lovastatin + warfarin combination (P=0.02), although the women on lovastatin alone also had a reduction in progression (P=0.09). Men experienced the greatest reduction with lovastatin alone (P=0.02), although there is a suggestion that warfarin may also reduce progression to some extent.

CONCLUSIONS

Lovastatin is beneficial in reducing disease progression in women and men. Warfarin has no effect in women, although it may reduce progression in men. In men, warfarin does not add to the benefit of lovastatin and has no advantage over lovastatin alone.

Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit

BACKGROUND

It has been argued that life support for the elderly should be limited to conserve resources. As this population increases, so will the importance of evaluating appropriate use of mechanical ventilation in this group.

OBJECTIVE

To determine whether age has an independent effect on the outcomes of patients treated with mechanical ventilation after admission to an intensive care unit (ICU).

DESIGN

Prospective cohort study.

SETTING

University-based tertiary care medical center.

PATIENTS

63 patients 75 years of age or older and 237 patients younger than 75 years of age enrolled from medical and coronary ICUs.

MEASUREMENTS

In-hospital mortality rate, duration of mechanical ventilation, lengths of stay in the ICU and in the hospital, and cost of care.

RESULTS

Median duration of mechanical ventilation was 4.2 days (interquartile range, 2.1 to 9.3 days) for patients 75 years of age or older and 6.4 days (interquartile range, 3.4 to 11.4 days) for patients younger than 75 years of age (P = 0.14). When the length of time required to "pass" a daily screening test of weaning variables was used as an indicator of recovery from respiratory failure, elderly patients passed earlier than younger patients (risk ratio, 1.58 [95% CI, 1.13 to 2.22]; P = 0.03). The cost of ICU care was lower for older ($12,822 [CI, $9821 to $26,313] than for younger ($19,316 [CI, $9699 to $39,950]) patients (P = 0.03). Median hospital costs tended to be lower in the older group ($21,292 compared with $29,049; P = 0.17). After adjustment for ethnicity, sex, and severity of illness in a multivariate logistic regression analysis, patient age of 75 years or older was predictive of 1 less day on the ventilator (CI, -2.8 to 1.2 days). Lengths of stay in the ICU (beta-coefficient, -0.5 days [CI, -3.0 to 2.7 days]) and in the hospital (beta-coefficient, 0.3 days [CI, -3.7 to 5.5 days]) did not differ for persons 75 years of age or older after these adjustments (P > 0.1). Intensive care unit and hospital costs, however, were lower for elderly persons (P = 0.02). The in-hospital mortality rate was 38.1% among elderly patients and 38.8% among younger patients (P > 0.2); Cox proportional hazards analysis confirmed that survival did not differ between the two groups (relative risk for older patients, 0.82 [CI, 0.52 to 1.29]).

CONCLUSIONS

After adjustment for severity of illness, elderly patients spent similar time on mechanical ventilation and in the ICU and hospital but had a lower cost of care than younger patients. These outcomes are not explained by differences in mortality rate and suggest that mechanical ventilation should not be restricted in elderly patients with respiratory failure on the basis of chronologic age.

Parental language and verbal responsiveness to children in crowded homes

This article is a secondary data analysis of the University of Kansas Language Acquisition Project, which intensively studied, on a regular basis, parent and child language from age 6 months to 30 months. The association between residential density and parent-child speech was examined. Parents in crowded homes speak in less complex, sophisticated ways with their children compared with parents in uncrowded homes, and this association is mediated by parental responsiveness. Parents in more crowded homes are less verbally responsive to their children. This in turn accounts for their simpler, less sophisticated speech to their children. This mediational pathway is evident with statistical controls for socioeconomic status. This model may help explain prior findings showing a link between residential crowding and delayed cognitive development.

The prognostic significance of passing a daily screen of weaning parameters

OBJECTIVE

While "weaning parameters" are commonly used to guide removal of mechanical ventilation devices, little information exists concerning their prognostic value. We evaluated whether passing weaning parameters was associated with survival.

DESIGN

A prospectively followed cohort of mechanically ventilated patients.

SETTING

Medical and coronary adult intensive care units of an 806-bed medical center.

PATIENTS

300 consecutively enrolled mechanically ventilated patients.

MEASUREMENTS AND RESULTS

216 patients who passed a daily screen of weaning parameters were more likely to be extubated successfully (87 vs 30%, p = 0.0001), less likely to require ventilation for > 21 days (3 vs 30%, p = 0.0001), and had a higher survival to hospital discharge (74 vs 29%, p = 0.0001) than 84 patients who never passed the screen. The overall accuracy of the daily screen for predicting successful extubation and in-hospital survival was 82 and 73%, respectively. Multivariate proportional hazards analysis of time until hospital death confirmed the beneficial effect of passing the daily screen (p = 0.01) and of duration of mechanical ventilation (p = 0.001) even after adjustment for differences in severity of illness, age, race, gender, diagnosis, and treatment assignment. While liberation from mechanical ventilation was predictive of survival at any time during the hospital stay (p = 0.001), the prognostic significance of the daily screen for hospital survival was related to how early after intubation it was passed. The difference in survival between patients who had passed and those who had not passed the daily screen was significant for 1 1/2 weeks postintubation but progressively decreased over time. The average time to extubation after passing the daily screen increased from 3 days (range 0 to 56), for those passing within 5 days of intubation, to 8 days (0 to 35), for those passing after 10 days of intubation (r = 0.26, p = 0.001).

CONCLUSIONS

Passing a daily screen of weaning parameters is an independent predictor of successful extubation and survival, but its prognostic value decreases over time. Time spent on mechanical ventilation after passing the daily screen presents an important opportunity to optimize liberation from the ventilator.

Variability in ultrasonic measurements of arterial stiffness in the Atherosclerosis Risk in Communities study

Arterial stiffness is emerging as an important risk marker for cardiovascular disease. Ultrasound-based measurements of arterial stiffness are in use by several large epidemiological studies. The reliability of ultrasonic measurements of arterial stiffness was assessed as part of one of these, the Atherosclerosis Risk in Communities (ARIC) study. ARIC, a prospective, four-center epidemiological study, used B-mode ultrasound with an electronic tracking device to measure arterial stiffness of the carotid artery. Oscillometric blood pressure measures were obtained before and after the arterial wall tracking. Measurement variability was estimated in 36 volunteers who were scanned at three visits conducted at 7- to 14-day intervals. Between- and within-person components of variation were estimated for arterial diameter and blood-pressure measurements. The correlation (R) between repeated measurements for pulse pressure, the percent change in arterial diameter (strain), and the percent and absolute change in the arterial area were 0.69, 0.67, 0.66 and 0.81, respectively. The R for the stress-strain elastic modulus (Ep), arterial distensibility, and arterial compliance were 0.66, 0.67, and 0.77, respectively. The R for the pressure-adjusted diameter change (i.e., diameter change adjusted for diastolic and pulse pressures) was 0.75. In summary, the ultrasonic measurements of arterial stiffness employed in the ARIC study demonstrate excellent short-term repeatability, demonstrating their utility in field settings.

Multiple metabolic syndrome is associated with lower heart rate variability. The Atherosclerosis Risk in Communities Study

OBJECTIVE

To test at the population level whether people with multiple metabolic syndrome (MMS) disorders have reduced cardiac autonomic activity (CAA).

RESEARCH DESIGN AND METHODS

We examined the association between the level of CAA and MMS disorders, at the degree of clustering and the segregate combination levels, using a random sample of 2,359 men and women aged 45-64 years from the biracial, population-based Atherosclerosis Risk in Communities (ARIC) Study. Supine resting 2-min beat-to-beat heart rate data were collected. High-frequency (HF) (0.15-0.35 Hz) and low-frequency (LF) (0.025-0.15 Hz) spectral powers, the ratio of LF to HF, and the SD of all normal R-R intervals (SDNN) were used as the conventional indices of heart rate variability (HRV) to measure CAA. The MMS disorders included hypertension, type 2 diabetes, and dyslipidemia.

RESULTS

HRV indices were significantly lower in individuals with MMS disorders. The multivariable adjusted mean HF was 0.85 (beat/min)2 in subjects with all three MMS disorders, in contrast to 1.31 (beat/min)2 in subjects without any MMS disorder. At the segregated combination level, the multivariable adjusted means +/- SEM of HF were 1.34 +/- 0.05, 1.16 +/- 0.05, 1.01 +/- 0.17, and 1.34 +/- 0.05 (beat/min)2, respectively, for subjects without any MMS disorder, with hypertension only, with diabetes only, and with dyslipidemia only, and the means +/- SEM of HF were 0.93 +/- 0.04, 0.70 +/- 0.15, and 1.20 +/- 0.05 (beat/min)2, respectively, for subjects with diabetes and hypertension, diabetes and dyslipidemia, and hypertension and dyslipidemia. An increase in fasting insulin of 1 SD was associated with 88% higher odds of having a lower HF. The pattern of associations was similar for LF and SDNN.

CONCLUSIONS

These findings suggest that MMS disorders adversely affect cardiac autonomic control and a reduced cardiac autonomic control may contribute to the increased risk of subsequent cardiovascular events in individuals who exhibit MMS disorders.

Chronic residential crowding and children's well-being: an ecological perspective

Chronic residential crowding is associated with difficulties in behavioral adjustment at school, poor academic achievement, heightened vulnerability to the induction of learned helplessness, elevated blood pressure, and impaired parent-child interpersonal relationships among a sample of working-class, 10-to 12-year-old children living in urban India. The significant main effects of residential crowding on blood pressure and learned helplessness are moderated by gender. Residential crowding is positively associated with blood pressure only among boys and with helplessness only among girls. All analyses statistically control for household income. We then demonstrate that perceived parent-child conflict functions as an underlying, intervening process that largely accounts for several correlates of household crowding among children.

Empathy: a study of two types

The time is long past for nurse researchers and educators to meet the challenge of scientific inquiry of those more abstract components of nursing that have been named the art of nursing and are now identified as dimensions of holistic nursing. C. Rinne (1987) stated that the art of nursing lies within the affective domain. Empathy is an important dimension of that domain and is focused on in the nursing literature. Nursing theorists prior to M. R. Alligood (1992) had not developed models that addressed empathy as more than a singular though multidimensional phenomenon. On the basis of a review of the literature in nursing and related disciplines, M. R. Alligood (1992) proposed two types of empathy: trained and basic. The purpose of this study was to examine (a) the differences between the two types of empathy, by evaluating scores from instruments that measured trained and basic empathy and (b) the endurance of empathy scores. Trained empathy was measured with the Layton Empathy Test, and basic empathy was measured with the Hogan Scale. Data were collected over time with 106 nursing students prior to, during, and after completion of a bachelor of science in nursing program at a large southeastern university. Analysis of the data confirmed the phenomenon of two types of empathy with differentiation in endurance that M. R. Alligood (1992) had proposed. The research results have implications for the way nursing educators prepare nurses. This study supports the finding that trained empathy is not sustained. The importance of measurement of students' baseline basic empathy is indicated. The practice of teaching empathy techniques is called into question, and new approaches to facilitate students' discovery of their basic empathy are indicated (M. R. Alligood, G. W. Evans, & D. L. Wilt, 1995).

Chronic stress and illness in children: the role of allostatic load

OBJECTIVE

Recent studies of stress have highlighted the contributions of chronic psychological and environmental stressors to health and well-being. Children may be especially vulnerable to the negative effects of chronic stressors. Allostasis, the body's ability to adapt and adjust to environmental demands, has been proposed as an explanatory mechanism for the stress-health link, yet empirical evidence is minimal. This study tested the proposition that allostasis may be an underlying physiological mechanism linking chronic stress to poor health outcomes in school-aged children. Specifically, we examined whether allostasis would mediate or moderate the link between chronic stress and health.

METHOD

To test the hypothesis that allostasis contributes to the relation between chronic stress and poor health, we examined household density as a chronic environmental stressor, cardiovascular reactivity (CVR) as a marker of allostatic load, and number of school absences due to illness as the health outcome in a sample of 81 boys.

RESULTS

Structural equation modeling indicated that the mediating model fit the data well, accounting for 17% of the variance in days ill.

CONCLUSIONS

Results provide the first evidence that CVR may mediate the relation between household density and medical illness in children. More generally, these findings support the role of allostasis as an underlying mechanism in the link between chronic stress and health.

Urban bus driving: an international arena for the study of occupational health psychology

This article offers a brief summary of the articles in this special issue, plus it provides a rationale for the scientific study of urban bus operation. Among the reasons to study urban transit operators are the following: Multimethodological, international data show that urban bus driving is an unhealthy occupation; psychosocial and environmental characteristics of the transit work setting portend ill health, plus these characteristics are readily discernible to the public; urban transit workforces well represent blue-collar populations; despite widespread changes in the nature of work related to technological innovations, mass-transit operation is likely to remain stable, and the "health" of the mass-transit industry has important implications for societal well-being; and finally, bus driving illustrates several important methodological challenges. The article concludes with an overview of future research.