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J R Atwood

Publications and source records attributed to J R Atwood.

At least 19 recordsLinked to original sources
PubMed1998

Estrogen profiles in postmenopausal African-American women in a wheat bran fiber intervention study.

High dietary fiber intake has been hypothesized to lower blood estrogen concentrations, an effect thought to be beneficial for decreasing breast cancer risk. This study investigated the association between dietary supplementation of wheat bran and circulating estrogen levels in postmenopausal African-American women participating in a community intervention trial. Seventeen postmenopausal women (aged 63 +/- 1.6 yr) participated in the study. Nutritional status was assessed and blood and 24-hour urine samples were collected before and after five to six weeks of daily supplementation of the diet with 35 g of wheat bran cereal (11.6 g insoluble dietary fiber) marked with 28 mg of riboflavin. Riboflavin confirmed that all postmenopausal participants adhered to the intervention protocol. Nine of the 17 postmenopausal women were taking some form of estrogen replacement therapy (PM-ERT). Baseline hormone levels in the PM-ERT group did not significantly change after the dietary intervention. Estradiol (96.8 +/- 20.3 vs. 113.8 +/- 23.3 pg/ml), androstenedione (0.47 +/- 0.06 vs. 0.45 +/- 0.06 ng/ml), and sex hormone-binding globulin (SHBG, 107 +/- 13.5 vs. 106.6 +/- 13.3 nmol/l) levels remained constant. In the eight postmenopausal women who were not receiving exogenous hormones (PM), wheat bran consumption was not associated with predicted decreased levels of estradiol (25.7 +/- 2.7 vs. 31.0 +/- 1.9 pg/ml), estrone (38.3 +/- 10.1 vs. 39.3 +/- 10.6 pg/ml), and androstenedione (0.78 +/- 0.08 vs. 0.68 +/- 0.11 ng/ml) or with increased concentrations of SHBG (35.2 +/- 6.4 vs. 34.8 +/- 6.5 nmol/l). Participants receiving ERT had baseline and postintervention levels of estradiol and SHBG significantly higher and androstenedione significantly lower than those not receiving ERT. No association between wheat bran supplementation and hormone levels was found in PM or PM-ERT African-American participants. These results in postmenopausal women are in contrast to findings of earlier studies in premenopausal women indicating that wheat bran fiber decreases serum sex hormones. Estrogen levels in postmenopausal women are only 5-10% of those in premenopausal women; therefore, a high wheat bran fiber diet alone may not be sufficient to depress these low levels even further.

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PubMed1997

Development of a urinary riboflavin adherence marker for a wheat bran fiber community intervention trial.

Development of a reliable marker of adherence to high-fiber diets is essential for accurately assessing dietary fiber intake in community interventions and clinical trials. The objective of this study was to evaluate the feasibility of using a riboflavin tracer incorporated into wheat bran cereal to determine fiber intake and compare results to the more traditional methodology of measuring stool weight. The inpatient phase of the study established that the excretion of urinary riboflavin was highly correlated with the dose of the riboflavin-spiked wheat bran cereal (r = 0.95, P < 0.005) and could be used as a biomarker to validate fiber supplement intake. The outpatient clinical intervention included a group of seven African-American men and women, who were asked to incorporate 1/2 cup of wheat bran cereal (11.6 g of dietary fiber) into their daily diet for a 6-week period. The cereal was spiked with a 28-mg dose of riboflavin. Baseline measurements of urinary riboflavin and stool weight were compared to postintervention levels. Comparison of pre- and postintervention measures of riboflavin excretion showed a significant increase (0.8 +/- 0.1 versus 6.0 +/- 0.6 mg/day, P < 0.02), which confirmed a high level of adherence to the dietary intervention. Although wet stool weights at baseline were significantly lower than postintervention (106 +/- 20 versus 146 +/- 23 g/day; P < 0.03), differences in dry stool weights did not reach significant levels (28 +/- 4 versus 33 +/- 5 g/day, P < 0.30). Furthermore, pre- and poststool measurements overlapped and could not provide definitive data on participant adherence. These results indicate that the riboflavin tracer was a more sensitive biomarker of wheat bran fiber supplementation than stool weight and provided an accurate method for validating adherence to the dietary intervention. A riboflavin marker provides a valid technique for adherence assessment in large-scale community trials, in which collection of 3-day fecal samples is not a manageable option.

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PubMed1996

Adherence enhancers in pill-related clinical trials: a health behavior in cancer prevention model-based approach.

Preventing non-adherence and treating adherence failure are important to consider in designing community-based clinical trials. The approach and methods for managing adherence are vital. This paper describes a practical and theoretically-based strategy for managing adherence in a small cancer prevention trial with subjects (n = 40) taking a non-steroidal anti-inflammatory drug, piroxicam. Average daily pill intake adherence was exceptionally high (97.4%) as measured by self-report calendar. Thus, the generalized adherence enhancement approach used in this study may have been a related factor, although statistical model-testing was not possible in this small trial. The generalized intervention took into account factors such as the potential barriers and benefits of being in the study, self-efficacy and satisfaction with the participant/staff relationship. These and other theoretical variables were incorporated into an overall adherence strategy that is discussed.

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PubMed1996

The development of the Pain Management Inventory for patients with arthritis.

The initial development of the Pain Management Inventory (PMI), a precise clinical index of pain management methods intended for use with patients with arthritis, is reported. The PMI differs from available instruments in its intent to assess specific methods that the individual is currently using for arthritis pain management and the perceived helpfulness of these methods, thus providing information to be used in combination with other clinical indicators for planning and evaluating ongoing pain self-management. Sixteen of 17 items, or methods, initially demonstrated content validity. Using methods appropriate for an index of independent items, psychometric testing with a sample of 82 persons having a primary diagnosis of osteoarthritis or rheumatoid arthritis then focused on estimating the construct validity and test-retest reliability of each item. Findings assist in better understanding how various methods relate to overall pain management when it is defined as successfully taking care of or handling the pain as viewed within a cognitive-behavioural framework. Findings suggest that there are eight items that represent valid and reliable pain management methods. These items should be used and evaluated with additional arthritis samples to determine whether the findings replicate.

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PubMed1992

The effectiveness of adherence intervention in a colon cancer prevention field trial.

BACKGROUND: Adherence interventions were implemented in a 1-year community-based colon cancer prevention clinical trial (n = 110) using wheat bran fiber and calcium dietary supplements. The adherence promotion strategy was guided by a theoretical model. METHODS: The adherence intervention contains both a generalized portion given to all participants and an individualized portion given to marginal (50-74% intake) and low (under 50% intake) adherers. A regression model was employed to assess the effectiveness of the interventions both at the first intervention and at subsequent times. RESULTS: The Health Behavior in Cancer Prevention Model-based adherence promotion intervention was associated with retention of participants, both during the run-in period and after randomization (P = 0.05); and maximization of the percentage of the 13.5-g recommended fiber supplement consumed during the trial (92.5%). The positive effects of the adherence intervention were greater with first-time nonadherers and the control group than with the experimental group. The high-fiber group had notably more biological GI effects from the increased fiber intake, more preexisting comorbidities, and lower perceived cognitive and physical health status. CONCLUSIONS: Randomized participants had excellent adherence overall. Retention rates in the trial were better than would be expected without the adherence intervention, especially among those participants who may have been at higher risk for dropping out of the study. This suggests that a systematic, theoretically based adherence strategy should be further tested in clinical trial settings in which lower adherence is a problem.

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PubMed1992

Reasons related to adherence in community-based field studies.

This study identified participants' reasons for good, marginal or poor adherence, or withdrawing from community-based clinical studies using a dietary and/or drug intervention. Adults aged 48-75 years participated in one of three studies related to decreasing colon polyp recurrence. Qualitative data from progress notes (N = 675) and end-of-study evaluations (N = 87) were coded using constant comparative analysis with 100% content validity panel agreement. Most common reasons for non-adherence were barriers such as side-effects, interference with vacation plans, unrelated illness, forgetting and competing outside stressors. Participation motivators were benefits such as altruism, medical benefits, free service and staff rapport. Findings supported the Health Behavior in Cancer Prevention model-based approach to adherence interventions and provided directions for adherence promotion in future community-based clinical studies.

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PubMed1992

Care needs of home-based cancer patients and their caregivers. Quantitative findings.

The purpose of this study was to identify care needs of home-based patients receiving treatment for cancer and their caregivers. The sample consisted of 30 patients receiving radiation therapy and/or immunologically based treatments for a variety of cancers and 29 caregivers. Patient and caregiver needs scales were used to elicit the needs of patients and caregivers. Patients and caregivers were able to cite their unique needs. Patients had more needs for themselves in the areas of personal care, activity management, and interpersonal interaction than did the caregivers. The necessity for individualization of care was noted by both patients and caregivers, an area that nursing is in a unique position to address.

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PubMed1991

A community-based feasibility study using wheat bran fiber supplementation to lower colon cancer risk.

METHODS: In this feasibility study, free-living older adults (n = 180; means = 67.5 years old) were randomly assigned to one of three levels of a 3-month standardized compliance enhancement program. RESULTS: Regarding subject compliance with the 18 g/day wheat bran fiber supplement, the high compliance enhancement group had a superior regimen compliance rate (88%) versus the medium and low groups, (66 and 29%, respectively) (P = 0.01), with similar attrition rates. CONCLUSION: No significant gastrointestinal side effects and changes in body weight were reported. For similar efficacy, the comprehensive compliance enhancement group had the greatest cost effectiveness.

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PubMed1990

An exploratory investigation of elders' views on diet, nutrition and cancer prevention.

The goal of this exploratory investigation was to describe views related to diet and cancer prevention among the residents of a southwestern retirement community. Ethnographic interviews were conducted with twelve residents, providing over 500 data bits for this investigation. Several categories representative of the elders' views related to diet and cancer prevention were identified using content analysis. These included Determinants of food choices, Vigilance and diet and Expectations related to diet and cancer prevention. Two cultural themes illustrated the semantic relationships among the categories: "It's not easy to change your diet, especially when you are all alone," and "Eating right helps you resist disease but it is just too late for us." As diet becomes a primary means of reducing one's risk for certain types of cancer, the informed expertise of nutrition educators and health practitioners is needed to assist the public in adopting dietary guidelines. Qualitative data, as presented here, will be useful in developing effective education materials to meet this need.

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PubMed1989

Perceived home care needs of cancer patients and their caregivers.

The purpose of this study was to identify perceived home care needs of outpatients receiving treatment for cancer and their caregivers. The purposive subsample consisted of 16 subjects, 8 patients receiving treatment as outpatients and their 8 caregivers. Two interview guides, one for the patients and the other for their caregivers, were based on the Neuman Systems Model to assess patient and caregiver stressors The data were analyzed in relation to intrapersonal stressors (within the individual), interpersonal stressors (between the individual and others), and extrapersonal stressors (between the individual and the environment) Several stressors within each category were identified by both the patients and caregivers. Intrapersonal stressors included treatment uncertainty and role change, the interpersonal stressor of lack of social support, and the extrapersonal stressors of lack of transportation and limited finances. In addition, patients identified specific intrapersonal stressors in relation to their situation. These included assistance in coping with physical restrictions resulting in subsequent anger and depression. On the other hand, intrapersonal stressors identified by the caregivers included support in coping with the added responsibilities in relation to patient care, the fear of being alone, guilt, and the interpersonal stressor of limited knowledge regarding the patient situation. The stressors identified by both the patients and caregivers can serve as a beginning means to explore the needs encountered by this population group.

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PubMed1988

Retaining qualitative validity while gaining quantitative reliability and validity: development of the Transition to Parenthood Concerns Scale.

This article raises issues about the retention of qualitative validity while establishing psychometric estimates of reliability and validity for a scale that was developed from inductively generated concepts to assess and evaluate the learning needs and concerns of expectant parents in the trimester before their baby's birth. A set of practical procedures for pilot testing qualitatively based scales is described. The three procedures, which provide estimates of clarity, apparent internal consistency, and content validity, preserve the assumptions underlying qualitative methods. The ratings from these procedures have provided a base for item and scale revisions and formal quantitative testing.

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PubMed1987

Innovative retention strategies for nursing staff.

The creation of innovative retention strategies will be a major focus for nursing administration as a shortage of nurses recurs and turnover of staff becomes a problem. A recent study provides information on which to formulate retention strategies. The findings suggest that retention strategies, to be effective, need to be targeted specifically to particular conditions of the nursing staff, e.g., educational preparation and the clinical service on which staff are functioning. The authors outline their research findings and the innovative strategies that have been constructed.

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