Biomedical subjects
Publications and source records attributed to V S Conn.
Meta-analysis research reports are increasingly found in the public health literature. Meta-analysis is a quantitative method for summarizing existing studies. Although it is often advocated to synthesize research, nurses must be able to read these reports critically to determine applicability to practice.
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Because of the considerable attention given to breast implants by the media, these two surveys were conducted to evaluate how women with breast implants think and feel about the current issues. A telephone questionnaire was administered to 60 women prior to the Food and Drug Administration's moratorium and again following the advisory panel recommendation. The second survey revealed that most subjects felt the media information was accurate, a significant (p = 0.02) change from the first survey responses. The most frequently cited concern about breast implants on the first survey was silicone leakage. It continued to be a major concern on the follow-up survey but was replaced by mammography concerns in the women with augmentation. Concern regarding autoimmune disease increased significantly on the follow-up survey (p = 0.0001). Satisfaction with the decision to have implants changed from 98 percent of the sample before the moratorium to 71 percent of augmentation patients and 79 percent of reconstruction patients after. Women willing to choose the procedure again also declined from 72 percent of reconstructive patients and 58 percent of augmentation patients before to 59 and 52 percent, respectively, after (p = 0.01). The majority (67 percent) acknowledged that the moratorium had an effect on their feelings about breast implants. Negative media information appears to have been a persuasive influence on patients' opinions regarding their implants.
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Older adults' use of over-the-counter (OTC) medications is usually a self-initiated behavior that may have important health consequences. A sample of 186 adults age 65 years and over was interviewed to describe their use of 16 OTC substances and their management of the most commonly used OTC medications. Subjects reported using almost twice as many OTC as prescription medications. A structured interview format elicited subjects' self-reports of decisions, judgments, and actions used to manage aspirins, laxatives, antacids, and vitamins. Most reported using the specific OTC preparations often. Health care providers were common but not exclusive sources of information about these products; few subjects acknowledged being influenced by advertisements. Although subjects' reported dosages and scheduling of agents were judged appropriate by nurses, some overuse of laxatives was noted, together with some continuation of laxative and antacid administration for excessive lengths of time for persisting symptoms. Few subjects identified precautions associated with the OTC medications. Questions were raised about older adults' perceptions regarding vitamin use for particular symptoms. The results of the study indicate the need for educational programs for older adults and further research about OTC substance use among these individuals.
Previous research has found over-the-counter (OTC) medication use not easily predicted from physical symptom experience. The purpose of this study was to examine the relationship between older adults' use of OTC medications and mood, social, health and demographic variables. Interviews were conducted with 186 adults aged 65 to 99 years. The mood variables of anxiety and depression were measured by the Profile of Mood States. The quality and degree of intimacy in a social relationship was measured by the Emotional Bondedness Scale. OTC medication use was measured by assessing frequency of OTC medication use, the total number of categories of OTC medication used, and the use of OTC medications in response to symptoms. Subjective health appraisal, number of chronic illnesses, number of prescriptive medications, the number of symptoms experienced in the previous month, and physician-office visit frequency were recorded. OTC medication use was predicted by the total number of symptoms experienced, emotional bondedness, age, anxiety, income, cohabitation status, and the frequency of physician-office visits. The total number of symptoms experienced accounted for more variance in OTC medication use than any other variable.
Little is known about women's and older adults' experiences after myocardial infarction (MI). The purpose of this study was to determine if gender and age differences exist in psychosocial condition, health state and therapeutic regimen adherence among MI survivors. Adults aged 40 to 88 years (n = 197) were interviewed 1 to 2 years after their first MI. The Profile of Mood States was used to measure anxiety and depression, the Personal Resources Questionnaire was used to measure social support, the Rosenberg Self-Esteem scale was used to measure self-esteem, the Perceived Quality of Life scale was used to measure quality of life, and the Health Behaviour Scale was used to assess therapeutic regimen adherence. Cardiac rehabilitation participation was recorded from rehabilitation centre records. Subjective health appraisals were assessed using investigator-developed questions. Increased age was associated with higher depression scores, lower quality of life, less social support, less participation in formal cardiac rehabilitation, less therapeutic exercise and poorer general health. Women reported poorer health than men. Findings indicated older males may be at risk for lower social support and continued smoking after infarction. These findings suggest that the often-reported experience of middle-aged males post-MI cannot be generalized to all adults experiencing infarction.
Two studies were conducted to examine the relationship between medication regimen complexity and adherence among older adults recently discharged from hospitals (N = 178) and those not recently hospitalized (N = 98). Medication regimen complexity was measured by the Medication Complexity Index (Kelley, 1988), which measures the number, frequency, and types of actions required to enact a medication regimen. Adherence to the regimen was measured by pill count and verbal self-report. The negative correlations between regimen complexity and adherence were in the predicted direction but did not achieve statistical significance. Medication regimen complexity may have a larger impact on aspects of medication management other than adherence to the prescriptive regimen.
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Eighty-six family caregivers participated in small group interviews about their experience of burden in caring for mentally ill relatives. Families experienced profound burdens as a result of their interactions with the mental health care system, particularly in negotiating crisis situations; acting as patient advocates and case managers; obtaining adequate community resources, continuity of care, and information; dealing with legal barriers; and communicating with mental health professionals. Recommended methods of reducing family burden and improving the care of the mentally ill who reside in the community are family education, inclusion of the family in treatment decisions, changes in current mental health laws, redirection in professional training, and development of mobile crisis teams.
Self-care actions used for joint symptoms were studied among independently living older adults. Fifty-three of 100 older adults interviewed reported 65 joint problems. Medication use was the most common self-care action reported (56%), followed by heat application (23%), exercise (13%), and rest (10%). Several self-care actions suggested in the professional literature were notably absent or infrequently used in this sample. Twenty percent of the reported joint problems were not treated with self-care actions. The need for joint rehabilitation education in this sample of older adults is well documented.
Rehabilitation programs for myocardial infarction (MI) survivors are designed to alter survivors' self-care patterns and to improve long-term physical and psychological outcomes. The purpose of this study was to examine the relationship between participation in cardiac rehabilitation and health state; days of reduced activity; anxiety; depression; self-esteem; quality of life; and performance of exercise, diet, medication, stress-modification, and smoking-reduction self-care behaviors after MI. Interviews were conducted with 197 women and men 1 to 2 years after their initial MI to measure health state, mood, self-esteem, quality of life, and relevant self-care behaviors. Rehabilitation center records were reviewed to determine participation in rehabilitation programs. Rehabilitation participation was significantly associated with health state; days of reduced activity; self-esteem; quality of life; and performance of exercise, diet, and medication self-care. These findings suggest that participation in cardiac rehabilitation is a worthwhile intervention that facilitates recovery from myocardial infarction.
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BACKGROUND: Despite the potential benefits of exercise, rates of exercise among older adults remain low. Self-efficacy expectation is the strongest correlate of exercise behavior or exercise behavior change. OBJECTIVES: To develop and test the predictive ability of a model of exercise among older adults. METHOD: The model's constructs related to exercise and self-efficacy included outcome expectancy, perceived barriers to exercise, perceived health, age, and lifelong leisure exercise among adults 65 to 100 years years of age (N=147). Data were collected by personal interview and analyzed with path analysis. RESULTS: Self-efficacy expectation had a strong direct effect on exercise. Outcome expectancy contributed little to exercise in the model. Perceived barriers and self-efficacy expectation, followed by age, exerted the most total influence on exercise scores. CONCLUSIONS: Lifelong leisure exercise exerts its influence on exercise through self-efficacy beliefs, further emphasizing the importance of efficacy. Also important are perceived barriers to exercise. Further research should examine self-efficacy expectations, perceived barriers, and age as predictors of exercise among older adults at different stages of health behavior change.
This article examines the relationship between anxiety, depression, quality of life, and performance of suggested self-care behaviors among older adult myocardial infarction survivors. Interviews were conducted with 94 adults aged 65 years and older. The Profile of Mood States was used to measure anxiety and depression. Quality of life was measured with the Perceived Quality of Life scale. The Health Behavior Scale was used to measure performance of suggested self-care behaviors (modify diet, administer medications, manage stress, exercise, and reduce smoking). Depression scores accounted for 49% of the variance in quality of life scores. Depression scores predicted each of the self-care behavior scores. Anxiety scores did not predict quality of life scores or any self-care behavior score. Findings suggest that mental health interventions should become an integral part of formal cardiac rehabilitation programs soon after the infarction; interventions for depression long after the infarction are needed as well.
The purpose of this study was to examine the relationship between trait and state anxiety experienced during hospitalization for an acute myocardial infarction and self-care behaviors several weeks after the infarction. Sixty-two male (n = 39) and female (n = 23) subjects were interviewed during their hospital stay and again 3 months after discharge. State and trait anxiety were measured by the Spielberger State-Trait Anxiety Inventory Test. Medication, exercise, smoking, diet, and stress management self-care were measured by Miller's Health Behavior Scale. The findings revealed low correlations between trait anxiety and exercise performance, medication administration, stress management, and smoking cessation behavior, and between state anxiety and smoking behavior. The findings were interpreted in light of the conceptual differences between state and trait anxiety, and suggest that mental health interventions during hospitalization should emphasize teaching patients to manage their own anxiety instead of directly intervening to reduce current levels of anxiety among this population.
OBJECTIVE: To describe the prevalence, incidence, management, and predictors of venous ulcers in residents of certified long-term-care facilities using the Minimum Data Set. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: 32,221 residents admitted to long-term-care facilities in Missouri between January 1, 1996, and October 30, 1998. MAIN OUTCOME MEASURES: Version 2.0 of the Minimum Data Set was utilized. Assessment items included selected measures from background information, disease diagnoses, physical functioning and structural problems, health conditions, oral/nutritional status, and skin condition. MAIN RESULTS: Venous ulcer prevalence on admission was 2.5%. The incidence of venous ulcer development for long-term-care residents admitted without an ulcer at 90, 180, 270, and 365 days after admission was 1.0%, 1.3%, 1.8%, and 2.2%, respectively. The most frequent skin treatments for residents with a venous ulcer were ulcer care, dressings, and ointments. Factors associated with venous ulcer development within a year of admission were diabetes mellitus, peripheral vascular disease, and edema. CONCLUSION: Venous ulcer prevalence and incidence are greater in the long-term-care population than in the community at-large. Residents with a venous ulcer are likely to have comorbid conditions such as diabetes mellitus, peripheral vascular disease, congestive heart failure, edema, wound infection, and pain. Based on these data, risk factors such as history of leg ulcers, recent edema, diabetes mellitus, congestive heart failure, or peripheral vascular disease should prompt clinicians to carefully plan care that will manage a resident's risk for venous ulcer development.
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