Search PubMed⌕ Search

Biomedical subjects

J T Hepworth

Publications and source records attributed to J T Hepworth.

At least 19 recordsLinked to original sources
PubMed2001

Anxiety and postoperative pain in children who undergo major orthopedic surgery.

Anxiety and pain are major concerns not only for children who undergo surgery, but also for their parents and health care professionals. A convenience sample of 74 adolescents who underwent major orthopedic surgery for repair of idiopathic scoliosis and their parents was used to investigate the relationships among children's and parents' preoperative and postoperative anxiety and children's postoperative pain. Age-appropriate versions of Spielberger's State-Anxiety scales measured children's and parents' anxiety, and a visual analog scale assessed children's pain intensities. Children's state anxiety increased from preoperative to postoperative levels, and their postoperative anxiety levels positively related to their pain intensities on days 2 and 4 following the operation. Parents' anxiety decreased from preoperative to postoperative levels, and their postoperative anxiety positively related to their children's postoperative anxiety. Studying both parents and children helped to explain the variance in children's self-reported anxiety. Parents' emotional states are important indicators of children's emotional states and, subsequently, their pain experience. The results of this study suggest that allowing children to assist in the assessment of their postoperative pain may help health care professionals better understand the subjective component of pain. The findings also emphasize the importance of including parents in future studies in which the aim is to understand children's behavioral responses and recovery outcomes.

Adolescent↗
PubMed2001

Prominence of withdrawal symptoms in polydrug-exposed infants.

The problem of licit and illicit drug use during pregnancy continues to be a major perinatal health issue in this country. It is estimated that 200,000 infants are born each year to women who used illegal drugs while they are pregnant. Much information is available regarding the physiologic and neurobehavioral signs and symptoms of withdrawal expressed in infants exposed in utero to individual substances such as heroin, marijuana, methadone, alcohol, barbiturates, and PCP. However, little information is available related to the signs and symptoms of withdrawal observed in infants exposed to many combinations of these drugs prenatally. Additionally, few reports discuss the most prominent signs and symptoms of withdrawal in infants exposed to one or many drugs in utero. This article describes the results of a study that provides new information regarding the most prominent signs and symptoms of withdrawal exhibited by infants exposed to polydrugs, such as alcohol, opiates, stimulants, and sedatives, during pregnancy.

Alcoholic Beverages↗
PubMed2001

Evaluation of an instrument for assessing behavioral change in sedentary women.

PURPOSE: To construct and evaluate a psychometric instrument for the assessment of behavioral change as a means for gaining insight into the development of more effective programs for promoting physical activity in women. DESIGN: A 16-item questionnaire was created and was administered three times (0, 6, and 12 months) to 181, 90, and 82 women, respectively, to determine the validity and reliability of the instrument. Participants were women 30-60 years of age, literate in English, and sedentary. METHODS: The data were analyzed using factor analysis to determine the most appropriate model for evaluating three theoretical constructs: (a) goal setting, (b) restructuring plans, and (c) relapse prevention and maintenance. RESULTS: A 3-factor model was shown to be appropriate; the instrument adequately distinguished the constructs goal setting and relapse prevention and maintenance, but did less well with the concept of restructuring plans, indicating that this concept may not be a separate entity. CONCLUSIONS: This study showed that this new instrument to evaluate behavioral change has important empirical applications. Each subscale can be used independently, depending on the needs of the investigator. This instrument will be useful for public health programs promoting physical activity in a sedentary population.

Adult↗
PubMed2001

Behaviors of very preterm neonates as documented using NIDCAP observations.

PURPOSE: The purpose of this study was to describe the range and frequency of behaviors in neonates 24-30 weeks postconceptional age (PCA) using the Newborn Individualized Developmental Care Assessment Program (NIDCAP). DESIGN: A prospective design with convenience sampling was used. SAMPLE: Starting 24-72 hours postnatally and continuing through 30 weeks PCA, 8,144 two-minute observations of 85 NIDCAP behaviors were collected and analyzed from 42 neonates born at 24-29 weeks gestation. MAIN OUTCOME VARIABLE: The main outcome variables were the frequencies of the 85 neonatal behaviors measured by the NIDCAP. Frequencies were organized first by subsystem (autonomic, motor, or state) and were categorized further based on week of PCA. Comparisons of behavioral frequencies by number of weeks PCA were completed using correlation and regression analyses. RESULTS: The most frequently observed behaviors were irregular respirations, pink color, postured flexion of the extremities, immature light sleep, and drowsiness. Least frequently observed behaviors consisted of burps, bowel movement, grunting, smooth motor movements, cooing, and speech movement. Regression analysis illustrated that the pattern of behavior was significantly similar week to week.

Autonomic Nervous System↗
PubMed2000

The conceptualization, measurement, and validation of transient mechanical birth trauma.

An index of transient mechanical birth trauma (TMBT), consisting of the presence or absence of molding, cephalohematoma, subconjunctival hemorrhage, body bruising, facial bruising, petechiae, forceps marks, diminished arm movements, and sensitivity to sudden position changes, was measured on a convenience sample of 196 healthy newborns. Six dimensions of the Neonatal Behavioral Assessment Scale (NBAS) and other newborn measures also were assessed. Vaginally delivered newborns had more TMBT than those delivered by cesarean section and of newborns delivered vaginally, macrosomics had more TMBT than nonmacrosomics. TMBT positively correlated with range of state, individual reflex items of resistance to left and right arm movement, predominant state during the NBAS exam, and time to complete the NBAS exam. TMBT negatively correlated with newborn state instability and 1- and 5-minute Apgars. The results supported the measure's validity and are discussed in terms of implications for practice and further research to explore TMBT's usefulness.

Birth Injuries↗
PubMed1999

Parent coping and child distress behaviors during invasive procedures for childhood cancer.

This study examines what parents identified as their primary stressor before their child's invasive procedure, what coping strategies were used to manage the stress, what level of distress their children experienced during each phase of the procedure, and whether parents' coping modes were associated with their children's distress. Twenty children with cancer from 3 to 11 years of age and the parent present during the procedure participated in the study. Parents' primary stressors were identified as uncertainty about parent role and anticipating the child's distress during the procedure. Although parents used both emotion-focused and problem-focused strategies for coping with their primary stressors, they primarily relied on emotion-focused strategies. Children experienced the most behavioral distress during the procedural phase, and girls exhibited more distress than boys. The parents' coping modes were not associated with their children's distress, but children of parents whose primary stressor was uncertainty about parent role had higher distress than children of parents whose primary stressor was anticipating the child's distress. The findings related to parents' stressors, their coping strategies, and their children's distress were consistent with previous research. Directions for future research and suggestions for dealing with invasive procedures for childhood cancer are described.

Adaptation, Psychological↗
PubMed1999

Behavioral responses of newborns of insulin-dependent and nondiabetic, healthy mothers.

The purpose of this study was to compare the behavioral responses of term newborns of insulin-dependent diabetic mothers (NDMs) with newborns of nondiabetic, healthy mothers. The research design involved matched controls with repeated measures. Participants included 40 NDMs matched with 40 newborns of nondiabetic, healthy mothers. The main outcome measures were the seven dimensions of the Neonatal Behavioral Assessment Scale (NBAS) and the modal response score. The results showed that NDMs performed significantly poorer than their matched controls on motor processes and reflex functioning. For all newborns, motor processes, autonomic stability, reflex functioning, and the modal performance score were better on Day 2 than Day 1. It was concluded that although NDMs' behavioral responses improved by Day 2, their overall pattern of responses could be described as listless or sluggish. Due to their poorer motor and reflex responses, NDMs may require increased efforts to facilitate sensitive maternal responding during their first days of life.

Adult↗
PubMed1999

Measures of body size based on height, weight, and reported ideal weight: conceptual distinctions and empirical demonstrations.

Using height, weight, and self-reported weight, eight additional measures of body size were computed. The purpose of this paper was to specify conceptual distinctions and test hypothesized relationships among those newly constructed measures. Using a sample of healthy African American and European American women, correlations among the measures and race differences were assessed. High correlations suggested only two independent constructs, but theoretical considerations would suggest retaining, in addition to the traditional measure of body mass index, three new constructs: ideal body mass, a discrepancy measure, and a desirability measure. The only significant race difference was on ideal body mass. African American women reported a larger ideal body mass index than European American women. The use of actual versus self-report measures of height and weight, different conceptualizations of ideal weight, and clinical implications also were discussed.

Adult↗
PubMed1998

A comparison of newborns' NBAS reflex responses using total and individual scores. Neonatal Behavioral Assessment Scale.

The purpose of this study was to compare results found using a total summative score of abnormal reflex responses with the results found using individual reflex scores. The 20 reflexes included as part of the Brazelton Neonatal Behavioral Assessment Scale (NBAS) were assessed on 196 neonates on the 1st and 2nd days postnatally. Differences due to of type of delivery, birth weight, whether their mothers were insulin-dependent diabetics or nondiabetics, and day of testing were assessed by using analysis of variance. The key results were that all effects found using the total reflex score were replicated with individual reflex scores and that individual reflex scores also revealed effects not shown using the total score. It was concluded that the individual reflex scores, rather than the total score, should be used when evaluating newborn reflex performance.

Adult↗
PubMed1997

Attention, coping, and activity in children undergoing orthopaedic surgery.

The purpose of this study was to determine how children's preoperative focus of attention on the stresses of surgery related to their preoperative coping and return to usual activities during recovery. Children's attention was classified according to three different foci: concrete-objective, emotion, and vague. Children (N = 97) between the ages of 8 and 17 years who were undergoing major orthopaedic surgery participated in the study. Data were collected the day before surgery, and at 3, 6, and 9 months postoperatively. Children who focused on the concrete-objective aspects of surgery had the most positive activity outcomes, followed by the emotion-focused attention group. Children who were classified as having vague focused attentions had the least favorable activity outcomes. When there were significant coping by attention interaction effects, vigilant copers who had a concrete-objective focus of attention had the most favorable activity outcomes at each time of measurement. Children who were able to focus their attention on concrete aspects of the experience tended to use vigilant coping and were able to return to their usual activities sooner.

Activities of Daily Living↗
PubMed1997

Newborn neurologic screening using NBAS reflexes.

The neurologic examination of the newborn infant is not easy. The nurse or physician must have technical skill in handling infants and be familiar with eliciting, scoring, and interpreting reflexes. Because it is too costly to conduct full neurologic exams on all newborns, a screening can be performed to help select infants for whom detailed examination is indicated. Given the trend to discharge term newborns within 12 to 24 hours following delivery and the importance of being sure that abnormalities have not been overlooked prior to discharge, completing a neurologic screen during this early time period is warranted. Although professionals have been trained and certified to conduct Neonatal Behavioral Assessment Scale (NBAS) exams for more than 20 years at NBAS Training Centers, the NBAS text does not adequately explain how to perform reflex assessments so they can be administered reliably across multiple examiners. This article describes how to perform these reflex assessments so they can be used consistently by nurses and physicians as a neurologic screen in a variety of settings.

Humans↗
PubMed1996

Age and gender differences in health services utilization.

The purpose of this study was to examine the health service utilization patterns of elderly male and female enrollees of a large urban staff model Health Maintenance Organization (HMO). This HMO offered a wide spectrum of managed care services for its beneficiaries. A cross-sectional design was employed. The 759 randomly sampled elderly enrollees ranged in age from 66 to 99, with an average of 77.15 years. Approximately 60% were male and 40% were female; thus, the sample was not representative of the national older adult population. Three utilization patterns indicated that there were (a) nonsignificant relationships between age or gender and urgent care visits, prescribed pharmaceuticals, and out-of-pocket costs for pharmaceuticals; (b) linear relationships between age and gender and visits to HMO primary care providers (-), home-health care visits (+), emergency care visits (+), hospitalizations (+), and MD visits during hospitalizations (+); and (c) age was curvilinearly related to use of both HMO specialists and non-HMO specialists. These findings suggest that use of acute care services, including hospitalizations, inpatient physician visits, and emergency services increase with age but the use of primary care providers decreases with age. Gender was not a significant modifier of the relationship between age and utilization.

Age Factors↗
PubMed1996

Indicators of differences in immunization rates of Mexican American and white non-Hispanic infants in a Medicaid managed care system.

Immunization levels of Mexican American and white non-Hispanic infants enrolled in Arizona's Medicaid managed care demonstration project, a prototype of the model proposed for a reformed health care system, were compared and the influence of sociodemographic characteristics, acculturation levels, health beliefs of the mothers, and infant health status on immunization levels were assessed. The study used data collected from office records, birth certificates, and household interviews. The random sample included 292 white non-Hispanic and 274 Mexican American infants. White non-Hispanic infants received more immunizations by age 1 than the Mexican American infants. However, after controlling for a full set of explanatory variables in a multiple regression analysis, ethnicity was no longer a significant predictor of immunization levels. Significant predictors of a higher number of immunizations included fewer siblings, older maternal age, and higher maternal education. Health insurance and enrollment in a managed care plan were not sufficient to ensure adequate immunization of these Medicaid enrolled infants. Results are discussed in terms of previous research and the essential functions of public health as outlined in the Institute of Medicine's Report on the Future of Public Health.

Adolescent↗
PubMed1995

Evolution of parental stress and coping processes: a framework for critical care practice.

Crisis theory, stress and coping theory, and research on parental stress and coping during pediatric critical care experiences are integrated into a conceptual framework for understanding, assessing, and ultimately intervening to reduce parental stress and bolster coping. Within this framework, cognitive appraisal of stress, coping and person and situation factors are discussed as important determinants of parents' adaptation to this stressful situation. The nurse's ability to respond to the evolving nature of parental stress and coping processes over the course of the experience enhances the use of the framework in designing coping interventions.

Adaptation, Psychological↗
PubMed1994

Use of perinatal and infant health services by Mexican-American Medicaid enrollees.

OBJECTIVES: Lack of health insurance and a regular source of medical care are barriers affecting use of health services by Mexican Americans. We studied perinatal and infant health service use by Mexican-American women and non-Hispanic white women and their infants enrolled in Arizona's Medicaid program and explored characteristics associated with use of health services. DESIGN: A descriptive comparative study that used data collected from office records, birth certificates, and household interviews. SETTING: Participants resided in the state's most populous county and were enrolled in the Arizona Health Care Cost Containment System, a health maintenance organization-oriented Medicaid demonstration project. SUBJECTS: Random sample of 308 Mexican-American mother-infant dyads and 312 non-Hispanic white mother-infant dyads. The women were enrolled before the sixth month of pregnancy and for 60 days post partum; their infants were continuously enrolled throughout their first year. OUTCOME MEASURES: Timing and number of prenatal visits and a modified Kessner Index, postpartum visits, number and purpose of office visits during the infants' first year, and immunizations received. RESULTS: Mexican Americans averaged fewer prenatal visits than non-Hispanic whites (8.6 vs 10.2 visits) and were less likely to have "adequate" care (41.1% vs 52.8%). Both groups of mothers are well below the 68% of women nationally who receive adequate prenatal care. Controlling for important socioeconomic status and cultural characteristics, ethnicity had a strong independent effect on the number of prenatal visits and adequacy of prenatal care. Mexican-American infants made fewer visits (8.2 vs 9.8) and completed fewer age-appropriate immunizations than non-Hispanic whites. CONCLUSIONS: Health insurance and a regular source of care are insufficient conditions for ensuring adequate use of maternal and child health services by Mexican-American Medicaid enrollees. Factors associated with their less frequent use of these preventive health services include higher numbers of children, transportation problems, and less assistance from their support system.

Acculturation↗
PubMed1994

Time series analysis of physiological response during ICU visitation.

Time series analysis (TSA) is an important statistical procedure for clinical nursing research. The current paucity of nursing research reports using TSA may be due to unfamiliarity with this technique. In this article, TSA is compared with the ordinary least squares regression model; validity concerns of time series designs are discussed; and concomitant and interrupted TSA of data collected on the effects of family visitation on intracranial pressure (ICP), heart rate, and blood pressure of patients in ICUs are presented. The concomitant TSA of the effect of family on ICP suggested that family presence tended to be associated with decreased ICP. Interrupted TSA indicated the effect of family on heart rate and blood pressure was not as consistent: The overall effect on blood pressure appeared to be negligible, and heart rate may increase overall. Restrictive visiting policies, once typical of intensive care units, should be reconsidered.

Blood Pressure↗
PubMed1994

Psychophysiological responses of parents to pediatric critical care stress.

Psychological factors are associated with how parents cope during a child's intensive care hospitalization. However, little is known about the role of physiological-stress responses in parents' coping and adaptation to such situations. This study investigates the relationship between parents' psychophysiological-stress responses, as measured by urine catecholamine excretion, and their coping and activities during a child's intensive care experience. Parents who appraised the situation as one that is amenable to change and who used more problem-focused strategies, such as seeking social support, had lower anxiety and lower catecholamine levels. Further, parents who were more problem focused performed more child care activities during the experience. The results of this study provide information for planning interventions to promote parental coping and adjustment to the child's critical care situation.

Adaptation, Psychological↗