Adolescent Characteristics, Suicide, and Bullying in High School

Youth Risk Behavior Survey 2011-2017 data were examined for associations among high school population subsets who self-reported suicide risk behaviors and experiences with bullying. High-school students who reported suicidal risk behaviors were 4.64 times more likely to have experienced bullying electronically. Ninth grade and female students were more likely than others to experience suicide risk behaviors and bullying. At the interpersonal level, school nurses are able to identify students who are experiencing bullying and who exhibit suicide risk behaviors. At the systems level, bullying prevention efforts should target all students. School nurses, administrators, policy makers, and health providers should consider data-driven recommendations in bullying prevention programs.

Restrictive Ventilatory Patterns in Residents of Continuing Care Retirement Communities

Restrictive ventilatory patterns (RVPs) in older adults may contribute to morbidity and decreased quality of life. The purpose of this study was to begin to understand (a) the number of older adults residing in Continuing Care Retirement Communities with RVPs, (b) factors associated with RVP, and (c) whether RVP is associated with ambulation level. This descriptive study was conducted at three sites. RVP was evident in 34 of the 65 participants (52%), and 33 (97%) of these were either moderate or severely restricted. Dementia, dyspnea, kyphosis, and lower muscle strength were significant predictors of RVP. Eighty percent of the nonambulatory participants had RVP and 38% of the ambulatory participants had RVP. Designing interventions to address modifiable factors associated with RVP may prevent respiratory infections, help people to achieve better lung health, and increase physical activity tolerance.

Relationship between person's health beliefs and diabetes self-care management regimen

PURPOSE

To examine the relationship between the health beliefs of Saudi adults with type 2 diabetes mellitus (T2DM) and their adherence to daily diabetes self-care management regimen. A secondary aim was to examine the health beliefs of adults with a diabetic foot ulcer (DFU) and participants without a DFU.

METHOD

Descriptive correlational design with a convenience sample of 30 participants. Participants were recruited for this pilot study from an outpatient clinic at King Abdulaziz Medical City in Riyadh. The participants completed self-reported questionnaires about their health beliefs, daily diabetes self-care management regimen, and demographic characteristics. Hierarchical multiple regression analysis was used to test the interaction effects.

FINDINGS

Participants who reported having a high internal health locus of control (IHLoC) and a high level of self-efficacy (SE) adhered well to their foot care regimen (P = .038). The more the participants believed that God controls their health, and the higher their SE, the greater the participant's adherence to their medication regimen (P = .035). The stronger the participant's belief that following their diabetes treatment regimen will lead to good outcomes, the greater the participant's adherence to their dietary regimen for those with a low IHLoC (P = .015). Participants with a high SE and reported that their doctor is able to help them control their diabetes were more likely to follow their dietary regimen (P = .048). Participants with a DFU reported having additional health conditions besides T2DM (P = .018) and had less than a college education (P = .015). Although participants with a DFU reported that they were responsible for their diabetes (P = .21), they stated that God manages their diabetes (P = .29), and the disease can be controlled based on luck (P = .10).

CONCLUSIONS

Participants' beliefs were found to influence their daily self-care management regimen. Further studies are needed using a larger sample.

Enhancing the Collection, Discussion and Use of Family Health History by Consumers, Nurses and Other Health Care Providers: Because Family Health History Matters

The family health history (FHH) has long been used by nurses and other health care providers in clinical practice to determine if an individual, their family members, or their future generations are at an increased risk of heritable disease development. Information gleaned from the FHH can be used to better integrate preventive strategies into the plan of care. This report presents a summary of an exploratory pilot study that focused on the collection and use of FHH among a targeted group of Midwestern men and women. Findings suggest a need for efforts to further enhance the public's awareness of the importance of FHH.

Knowledge, group-based medical mistrust, future expectations, and perceived disadvantages of medical genetic testing: perspectives of Black African immigrants/refugees

BACKGROUND

Reasons for low participation of ethnic minorities in genetic studies are multifactorial and often poorly understood. Based on published literature, participation in genetic testing is low among Black African immigrants/refugees although they are purported to bear disproportionate disease burden. Thus, research involving Black African immigrant/refugee populations that examine their perspectives on participating in genetic studies is needed.

OBJECTIVES

This report examines and describes the knowledge of medical genetics, group-based medical mistrust, and future expectations of genetic research and the influence of these measures on the perceived disadvantages of genetic testing among Black African immigrants/refugees.

METHODS

Using a cross-sectional survey design, a nonprobability sample (n = 212) of Black African immigrants/refugees was administered a questionnaire. Participants ranged in age from 18 to 61 years (mean = 38.91, SD = 9.78). The questionnaire consisted of 5 instruments: (a) sociodemographic characteristics, (b) Knowledge of Medical Genetics scale, (c) Group-Based Medical Mistrust Scale, (d) Future Expectations/Anticipated Consequences of Genetics Research scale, and (e) Perceived Disadvantages of Genetic Testing scale.

RESULTS

Participants were concerned that genetic research may result in scientists 'playing God,' interfering with the natural order of life. In multivariate analyses, the perceived disadvantages of genetic testing increased as medical mistrust and anticipated negative impacts of genetic testing increased. Increase in genetic knowledge contributed to a decrease in perceived disadvantages.

CONCLUSIONS

Our findings suggest that recruitment of Black African immigrants/refugees in genetic studies should address potential low knowledge of genetics, concerns about medical mistrust, the expectations/anticipated consequences of genetic research, and the perceived disadvantages of genetic testing.

Single-protein nanomechanical mass spectrometry in real time

Nanoelectromechanical systems (NEMS) resonators can detect mass with exceptional sensitivity. Previously, mass spectra from several hundred adsorption events were assembled in NEMS-based mass spectrometry using statistical analysis. Here, we report the first realization of single-molecule NEMS-based mass spectrometry in real time. As each molecule in the sample adsorbs on the resonator, its mass and position of adsorption are determined by continuously tracking two driven vibrational modes of the device. We demonstrate the potential of multimode NEMS-based mass spectrometry by analysing IgM antibody complexes in real time. NEMS-based mass spectrometry is a unique and promising new form of mass spectrometry: it can resolve neutral species, provide a resolving power that increases markedly for very large masses, and allow the acquisition of spectra, molecule-by-molecule, in real time.

Dietary and physical activity patterns: examining fathers' perspectives

PURPOSE

Obesity adversely affects children, yet limited information is available on the familial environmental influence of fathers. The purpose of this study was to examine fathers' influences on their children's eating and activity patterns.

DESIGN AND METHODS

Participants for this mixed methods study was a convenience sample of 51 multi-ethnic fathers of children 8-12 years of age, who completed surveys addressing dietary and physical activity behaviors.

RESULTS

An association was found between fathers' and children's weight status. Half the children snacked without parental guidance.

PRACTICE IMPLICATIONS

Nurses need to assist children and their families to develop effective weight management strategies.

Smoking-related health behaviors of employees and readiness to quit: basis for health promotion interventions

This report describes patterns of cigarette smoking and interest in smoking cessation programs among employees in a public worksite (n = 6,000) and a private worksite (n = 14,000). Of the 622 employees who attended an employee assistance program (EAP) orientation, 110 (18%) were current smokers. A significantly greater proportion of public employees smoked cigarettes, smoked more heavily, and evaluated their health more poorly compared to private employees. Smokers in both sites were over-represented in unskilled positions. Regardless of worksite, respondents who smoked had similar desires to quit or cut down and were annoyed by the comments of others, felt guilty about smoking, awakened with a desire to smoke, and felt they had a smoking problem. Overall, more than one third of individuals were interested in joining a smoking cessation program. Occupational health nurses may use these findings to design and implement smoking cessation interventions in their workplaces.

Coping strategies utilized by adolescents with end stage renal disease

Children and adolescents with end stage renal disease (ESRD) require life-long treatment. The purpose of this descriptive investigation was to identify coping strategies that adolescents with ESRD use to manage their chronic illness. Participants for this investigation were 35 adolescents, 13-18 years of age, with ESRD. The A-COPE survey instrument was used in a clinical and camp setting to measure the coping strategies used by adolescents with ESRD. Analyses revealed that adolescents with ESRD utilized a variety of coping strategies to manage the stresses of living with their chronic condition. Personal characteristics of gender, transplant status, age, and religious views were significantly related to the coping strategies the adolescents reported using.

Eleven years of primary health care delivery in an academic nursing center

Academic community nursing centers (CNCs) emphasize partnership with the communities they serve to provide access to services that promote, restore, and maintain health. In this study, selected data from an 11-year clinical data set are presented to show the scope of academic CNC nursing practice, describe client services and expanded nursing roles, show the use of a computerized clinical documentation system in tracking nursing practice, and assess the usefulness of the Lundeen conceptual model. The study design was a retrospective review of computerized client record data. The setting was a CNC located in the neighborhood center of a large federally subsidized housing development. The sample was 25,495 client visits to the CNC. Visit data were coded and entered into a relational data management program to facilitate analysis. Findings show an expansion over time of nursing practice and client services that include strong case management and management of illness care. Findings also suggest that a computerized clinical documentation system that specifically tracks nursing practice is vital if nurses are to identify and eventually be reimbursed for client care specific to nursing practice. Finally, the Lundeen conceptual model was shown to be useful across the continuum of care provided at CNCs.

An intervention to increase coping and reduce health care utilization for school-age children and adolescents with sickle cell disease

The purpose of this study was to examine whether coping with pain changed immediately and one year after a self-care intervention for school-age children and adolescents with sickle cell disease (SCD). Sixty-five children and 32 adolescents attended an educational program for living with SCD. They were then randomly assigned to relaxation, art therapy or attention-control groups. Coping was measured before, after the intervention, and 12 months later. Thirty-three children and 14 adolescents completed the one year follow-up. Although there was no significant increase in the overall number of coping strategies school-age children and adolescents used from baseline to 12 months, there was a significant increase in those strategies specifically targeted by the intervention. For adolescents, there was a significant increase in the total number of coping scores used before the intervention and one year later. When compared to well African-American adolescents, overall coping scores in this sample were significantly lower. Health care utilization related to clinic visits, emergency department visits and hospitalizations decreased significantly for all participants in the study.

Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses

BACKGROUND

High levels of stress and the challenges of meeting the complex needs of critically ill children and their families can threaten job satisfaction and cause turnover in nurses.

OBJECTIVE

To explore the influences of nurses' attributes, unit characteristics, and elements of the work environment on the job satisfaction of nurses in pediatric critical care units and to determine stressors that are unique to nurses working in pediatric critical care.

METHOD

A cross-sectional survey design was used. The sample consisted of 1973 staff nurses in pediatric critical care units in 65 institutions in the United States and Canada. The following variables were measured: nurses' perceptions of group cohesion, job stress, nurse-physician collaboration, nursing leadership, professional job satisfaction, and organizational work satisfaction.

RESULTS

Significant associations (r = -0.37 to r = -0.56) were found between job stress and group cohesion, professional job satisfaction, nurse-physician collaboration, nursing leadership behaviors, and organizational work satisfaction. Organizational work satisfaction was positively correlated (r = 0.35 to r = 0.56) with group cohesion, professional job satisfaction, nurse-physician collaboration, and nursing leadership behaviors. Job stress, group cohesion, job satisfaction, nurse-physician collaboration, and nursing leadership behaviors explained 52% of the variance in organizational work satisfaction. Dealing with patients' families was the most frequently cited job stressor.

CONCLUSIONS

Job stress and nursing leadership are the most influential variables in the explanation of job satisfaction. Retention efforts targeted toward management strategies that empower staff to provide quality care along with focal interventions related to the diminishment of stress caused by nurse-family interactions are warranted.

Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses

BACKGROUND: High levels of stress and the challenges of meeting the complex needs of critically ill children and their families can threaten job satisfaction and cause turnover in nurses. OBJECTIVE: To explore the influences of nurses' attributes, unit characteristics, and elements of the work environment on the job satisfaction of nurses in pediatric critical care units and to determine stressors that are unique to nurses working in pediatric critical care. METHOD: A cross-sectional survey design was used. The sample consisted of 1973 staff nurses in pediatric critical care units in 65 institutions in the United States and Canada. The following variables were measured: nurses' perceptions of group cohesion, job stress, nurse-physician collaboration, nursing leadership, professional job satisfaction, and organizational work satisfaction. RESULTS: Significant associations (r = -0.37 to r = -0.56) were found between job stress and group cohesion, professional job satisfaction, nurse-physician collaboration, nursing leadership behaviors, and organizational work satisfaction. Organizational work satisfaction was positively correlated (r = 0.35 to r = 0.56) with group cohesion, professional job satisfaction, nurse-physician collaboration, and nursing leadership behaviors. Job stress, group cohesion, job satisfaction, nurse-physician collaboration, and nursing leadership behaviors explained 52% of the variance in organizational work satisfaction. Dealing with patients' families was the most frequently cited job stressor. CONCLUSIONS: Job stress and nursing leadership are the most influential variables in the explanation of job satisfaction. Retention efforts targeted toward management strategies that empower staff to provide quality care along with focal interventions related to the diminishment of stress caused by nurse-family interactions are warranted.

Urinary incontinence: treatments, interventions, and outcomes

The central theme of this article is the development of clinical outcomes and interventions by CNSs to enhance the quality of care provided by nurses. This was done using findings from three funded research projects conducted by the authors. The outcomes begin with measurable nursing diagnoses and continue with searches for remedial risk factors, assessment, and remedies. The interventions encourage responsible behaviors by elders that are individualized prevention and/or treatments for a given diagnosis. A brief synopsis of the research results is included.

Use of the nursing minimum data set to describe nursing interventions for select nursing diagnoses and related factors in an acute care setting

This study describes the prevalence of nursing interventions across six nursing diagnoses and their related factors using the framework of the Nursing Minimum Data Set (NMDS). Six nursing diagnoses (pain, potential for injury, anxiety, decreased cardiac output, potential for infection, and knowledge deficit) were among the most prevalent in an acute care setting studied in 1991. The NMDS and a nursing information system using standardized classification systems for nursing diagnoses and interventions provided an opportunity to describe nursing practice. Multiple related factors were identified across all six nursing diagnoses; three or four were selected frequently within each diagnostic category. The related factors also influenced the selection of interventions. Implications for the development of nursing classification systems and recommendations for further research are described.

Concerns of childbearing women: a Maternal Concerns Questionnaire as an assessment tool

OBJECTIVE

To determine if a tool measures maternal concerns in different populations of women.

DESIGN

Secondary analysis of data in five master's theses using the Maternal Concerns Questionnaire.

SETTING

Data were collected in postpartum units and homes. Populations were composed of rural and urban women.

PARTICIPANTS

Five groups of childbearing women (N = 187) during the antepartum or postpartum periods.

MAIN OUTCOMES

Subjects responded to 46 items related to concerns about themselves and their infants, partners, families, and community activities.

RESULTS

The Maternal Concerns Questionnaire discriminates specific concerns between populations.

CONCLUSIONS

The Maternal Concerns Questionnaire can be used in clinical practice to identify the specific concerns of mothers. The information gained can be used to individualize nursing-care plans and to measure outcomes.

Factors influencing weight gain after renal transplantation

Weight gain following renal transplantation occurs frequently but has not been investigated quantitatively. A retrospective chart review of 115 adult renal transplant recipients was used to describe patterns of weight gain during the first 5 years after transplantation. Only 23 subjects (21%) were overweight before their transplant. Sixty-six subjects (57%) experienced a weight gain of greater than or equal to 10%, and 49 subjects (43%) were overweight according to Metropolitan relative weight criteria at 1 year after transplantation. There was an inverse correlation between advancing age and weight gain, with the youngest patients (18-29 years) having a 13.3% weight gain and the oldest patients (age greater than 50 years) having the lowest gain of 8.3% at 1 year (P = 0.047). Black recipients experienced a greater weight gain than whites during the first posttransplant year (14.6% vs. 9.0%; P = 0.043), and maintained or increased this difference over the 5-year period. Men and women experienced comparable weight gain during the first year (9.5% vs. 12.1%), but women continued to gain weight throughout the 5-year study (21.0% total weight gain). The men remained stable after the first year (10.8% total weight gain). Recipients who experienced at least a 10% weight gain also increased their serum cholesterol (mean 261 vs. 219) and triglyceride (mean 277 vs. 159) levels significantly, whereas those without weight gain did not. Weight gain did not correlate with cumulative steroid dose, donor source (living-related versus cadaver), rejection history, pre-existing obesity, the number of months on dialysis before transplantation, or posttransplant renal function. Posttransplant weight gain is related mainly to demographic factors, not to treatment factors associated with the transplant. The average weight gain during the first year after renal transplantation is approximately 10%. This increased weight, coupled with changes in lipid metabolism, may be significant in terms of altering risk from cardiovascular morbidity.

Relationship between neonatal birth weight and maternal plasma amino acid profiles in lean and obese nondiabetic women and in type I diabetic pregnant women

Profiles of hemoglobin A1c (HbA1c) and concentrations of plasma glucose and 18 plasma amino acids were obtained in ten nonobese, insulin-dependent type I diabetic women, in 9 age- and weight-matched normal women and in ten obese nondiabetic women throughout pregnancy and postpartum. In late gestation, the period of maximum fetal growth, average HbA1c, plasma glucose, and total amino acid concentrations in diabetic mothers were significantly elevated above lean control values. No differences existed between the obese and lean control groups. Lean diabetic mothers also had significantly heavier babies (mean +/- SEM) relative to the 50th percentile for gestational age and sex (119 +/- 9%) than did the lean control group (94 +/- 3%, P less than .05). Relative birth weights among control lean and obese mothers did not differ significantly (94 +/- 3% v 104 +/- 5%). Late pregnancy profiles of HbA1c and average plasma glucose did not correlate with relative weight of neonates whereas average total plasma amino acids and six individual amino acids did correlate with this parameter. These data suggest that maternal plasma amino acid concentrations may influence fetal weight generally and may have an important role in the development of fetal macrosomia in diabetic pregnancies.

The association of smoking with clinical indicators of altered sex steroids--a study of 50,145 women

This study was designed to test the association of smoking with four clinically apparent conditions that may be related to altered sex steroids: natural and induced menopause, infertility, oligomenorrhea, and hirsutism. Data were obtained from the personal inventories of 50,145 women ages 20-59 years in TOPS, a weight reduction program. The age-adjusted odds ratios of each condition for heavy smokers compared with nonsmokers were 1.59 for natural menopause, 1.49 for induced menopause, 1.35 for infertility, 1.30 for oligomenorrhea among women younger than 40 years, 1.63 for oligomenorrhea among women 40-49 years, and 1.54 for hirsutism (P less than .05 for oligomenorrhea and P less than .001 for all other risks). The odds ratios were not substantially changed after adjustment for obesity, parity, and husband's education level. These results suggest that smoking may affect the ovaries or hormone metabolism, or both, with medical and cosmetic consequences.

The association of obesity with joint pain and osteoarthritis in the HANES data

Data from 4225 persons from the National Health and Nutrition Examination Survey (HANES) was used to determine whether obesity was associated with osteoarthritis (OA) or joint pain. Subjects were divided into four groups on the basis of sex and race. We found that obesity was associated with OA of the knee for each sex/race group (p less than 0.01). The association was strongest for women, and it was present even for subjects without evidence of knee pain on physical examination. Frame size was not significantly associated with OA of the knee. Relative weight was weakly associated with OA of the hips in white women and nonwhite men but not significantly associated with OA of the sacroiliac joint. Diabetes did not seem to be an important risk factor for OA. These results suggest that the additional mechanical stress resulting from obesity is the principal reason for the association between obesity and OA.

Relationship of body fat distribution to blood pressure, carbohydrate tolerance, and plasma lipids in healthy obese women

In 110 obese, healthy women, a relationship was sought between distribution of body fat and blood pressure, glucose tolerance, plasma insulin, and fasting plasma lipid and serum uric acid concentrations. The index of body fat distribution was the ratio of waist circumference to hips circumference (WHR). The WHR range in this group was 0.5 to 0.99, with a median value of 0.78. Positive, significant correlations were found between WHR and both systolic and diastolic blood pressure and between WHR and the total integrated plasma glucose and insulin responses during 4 hr oral glucose tolerance tests. No relationship was found between WHR and age, the degree of obesity as defined by the weight-to-height ratio, or concentrations of fasting plasma free fatty acids, plasma triglyceride, plasma cholesterol, or serum uric acid. Subsequently, 27 women in the highest quartile of the WHR range (0.83 to 0.99) were compared to 28 age- and weight-matched subjects in the lowest quartile of WHR (0.5 to 0.73). Women in the highest quartile had systolic and diastolic blood pressure as well as total plasma glucose and insulin responses during glucose tolerance tests that significantly exceeded mean values of subjects in the lowest quartile. We conclude that in healthy, obese women, a continuum exists that relates increasing fat accumulation in the upper body to progressively higher blood pressure, reduced carbohydrate tolerance, and higher plasma insulin concentrations. These changes occurred independently of age of degree of obesity in this population.