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Health-promoting behaviors of sheltered homeless women.

To expand the body of knowledge and provide further insight into the complex area of homelessness and health, health practices of sheltered homeless women were investigated using a cross-sectional, descriptive, and non-experimental design using Pender's Health Promotion Model as the theoretical framework. The sample (n=137) was well educated, mostly unemployed, primarily single, and homeless due to relationship problems/conflict per self-report. Homeless women were noted to practice health-promoting behaviors in all areas but scored the lowest on physical activity and nutrition. Significant findings reflected women's personal strengths and resources in the areas of spiritual growth and interpersonal relations.

Adolescent↗

Tracing the evolution of pluralism in community-based coalitions.

In this study, a crisis of leadership succession led to greater subsequent pluralism by the previously less inclusive coalition. Substantial tension existed between both coalitions and the federally funded Appalachia Cancer Network, especially around its evidence-based mission. The fact that this tension occurred even at the more locally inclusive site indicates that pluralism may vary across levels within the same coalition. This article contributes to theory by exploring how coalitions evolve over time across community boundaries, as well as to management practice by yielding guidance about how to build inclusive organizations.

Appalachian Region↗

Self-mutilation and the borderline personality.

As part of a larger study of pathological self-injury, 14 self-mutilators and 14 psychiatric controls matched for age, sex, and inpatient/outpatient status were administered the Diagnostic Interview for Borderlines. Consistent with Gunderson's theory of borderline personality disorder, the self-mutilators scored significantly higher on impulse-action patterns, affects, psychoticism, and interpersonal relations as well as on the total borderline index. A review of clinical records likewise revealed that self-mutilators were more likely than controls to have been diagnosed as borderline and to have received a greater number of different diagnoses during their treatment career. The results have implications for developmental theory, diagnosis, and treatment and provide support for the construct validity and clinical utility of the borderline syndrome and the Diagnostic Interview for Borderlines.

Adult↗

Teaching is more than telling: education about prematurity in a prenatal clinic waiting room.

The purpose of this article is to describe the potential of pre-natal clinic waiting rooms for delivering prematurity prevention programs. The model is adapted from the psychoeducational model of prepared childbirth with goals in three areas: (1) information about prematurity, (2) coping skills to promote behaviors that reduce prematurity, and (3) psychological support. Cornerstones of the model include content, process, and outcome components. Content is based on Moore and Freda's seminal work on prematurity prevention (1998); process is based on the classic work of Peplau on interpersonal relations (1952); and outcomes summarize the current research on expanded prenatal care services. The article concludes with implications for future research in expanding the levels of intervention to include the broader community and health policy.

Female↗

Adolescent suicide attempts and borderline personality disorder: clinical features.

Although suicide among adolescents has been increasing over the past decade, there are surprisingly few clinical studies regarding teen-agers who have attempted suicide. A previous study showed borderline personality disorder as the most common underlying personality problem among a group of predominantly hospitalized adolescents. This paper focuses on the clinical characteristics of 22 teen-agers with a borderline personality disorder who had attempted suicide. The essential pattern of a borderline personality was a persistent instability in a variety of areas, including interpersonal relations, mood, behavior, and self-image. The most prominent characteristics associated with suicide attempts by these adolescents were a tendency to react severely to loss, poorly controlled anger, and self-defeating impulsivity. Many of the characteristic behavioral symptoms of these borderline patients must be determined by a longitudinal history of the teen-ager's life. Specific treatment approaches are needed for these patients.

Adolescent↗

Empathy and social-emotional factors in recovery from stroke.

There is growing interest in evaluating the social and emotional effects of stroke, with the aim of improving recovery and outcome. Recent investigations indicate that post-stroke depression and social impairment are cross-cultural consequences that affect between one-third and two-thirds of patients. These conditions appear to be undertreated, even though studies confirm measurable benefits of medical and caregiver education interventions. A further improvement in outcome can be expected from the comprehensive recognition and management of other social and emotional alterations that encompass emotion-related communication disorders, reduced emotional arousal, initiation and expression, and impaired social cognition, empathy and related interpersonal competencies.

Empathy↗

Depressive symptoms decline among persons on HIV protease inhibitors.

OBJECTIVE: To ascertain whether initiation of protease inhibitors was associated with a change in depressive symptoms among persons infected with HIV. METHODS: Study subjects included men and women who were enrolled in the HIV/AIDS Drug Treatment Program and who had completed an annual participant survey before and after initiating triple combination therapy with a protease inhibitor. Depressive symptoms were assessed using the Centre for Epidemiologic Studies-Depression scale (CES-D). Statistical analyses to determine the change in CES-D total and subscale scores before and after protease inhibitor use were conducted using parametric and multivariate methods. RESULTS: Our analysis was restricted to 453 participants. Of these 234 (52%) were depressed at baseline (CES-D score > or = 16). Compared with nondepressed participants, depressed participants were slightly younger (p = .048), less likely to be employed (p < .001) and more likely to have an annual income less than $10,000 per annum (p < .001). After adjusting for CD4 count, employment status, income, age, and CES-D total or subscale score at baseline, we found a significant improvement in total scale score (p = .001) and depressive mood (p = .002), positive affects (p = .005), and somatic symptoms (p = .011) subscale scores at follow-up. There was no significant change in the interpersonal relations score over the study period. CONCLUSION: Our findings indicate that in addition to conferring impressive clinical benefits, protease inhibitor use is associated with a significant improvement in HIV-positive individuals' mental health.

Adult↗

Promoting physical activity among Taiwanese and American adolescents.

The purpose of this paper is to present a comparative analysis of the determinants of physical activity among adolescents in Taiwan and in the United States. Pender's Health Promotion Model (HPM) served as the theoretical framework for both studies (Pender, 1996). The major determinants of health behavior in the HPM are perceived benefits, perceived barriers, self-efficacy, activity-related affect, interpersonal influences, situational influences, commitment to a plan of action, and immediate competing demands. In Taiwan, 969 middle school students (55% males; 45% females) from Taipei provided data for the study. In the United States, the sample was collected from 286 late elementary and middle school students (48% males; 52% females). Results showed the gender differences in activity levels were apparent in the youths from both countries. In both Taiwanese and American youths, boys were more active than girls. Cross-cultural differences in the importance of barriers to physical activity emerged. Among Taiwanese adolescents, barriers did not emerge as a significant direct predictor of physical activity as they did among US adolescents. Perceived efficacy directly predicted physical activity among Taiwanese youths while it indirectly predicted physical activity and appeared to be mediated by beliefs regarding exercise benefits and barriers among American youths. In addition, the paths of effect for interpersonal influences were different when Taiwanese and US youths were compared. The findings from this paper have important and culturally-relevant information that can inform future physical activity intervention studies with diverse adolescents.

Adolescent↗

Medication and skilled work.

There is increasing interest in the way in which drugs impair performance. This has arisen because some may impair day-to-day skills of those whose occupations demand vigilance and motor skill, and of those who are involved in decision making or where interpersonal relations are crucial. For many years the position was adopted, at least in certain occupations where impaired performance could be a danger to others, that the use of any drug should preclude employment. However, recent advances in therapeutics and a greater understanding of drug action in man has made this rather uncomplicated view of life less tenable, and there is now an increasing desire that advances in therapy should, if at all possible, be available to occupational groups, such as airline pilots. In this way the adverse effect which a drug may have on performance has become an important aspect of its clinical profile. Hypnotics appropriate for transient insomnia, which may arise from the irregularity of rest inherent in many occupations, need to be free of residual effects, antihistamines that are sedative must be avoided, and drugs used in the management of mild hypertension, often during the important years of middle life, must be as free as possible from central effects. And it must be emphasized that these drugs are often used by active, healthy or near healthy individuals. The issues involved in the safe use of a particular drug by a particular individual are complex, and as with all aspects of therapeutics it is sometimes necessary to balance efficacy and adverse effects.

Drug-Related Side Effects and Adverse Reactions↗

A naturalistic test of Peplau's theory in home visiting.

Nurse-client relationships have been considered the foundation of successful home-visiting programs for vulnerable families. Even though nurse-client relationships are important when working with multiproblem families, relationship theory has not been used to guide interventions in home visiting. Identification of a fitting theory could provide direction for tailoring interventions to families at a "dose" individualized to meet their needs. This article reports a small study that tested the applicability of Peplau's theory of interpersonal relations in nursing (Peplau, 1952/1991) in the context of home visiting. Five prenatal clients and public health nurses participated in the study. Home visits were observed and audio-recorded beginning with the first prenatal home visit and ending in the early postpartum period. Audiotapes were transcribed and analyzed using a start list of codes based on Peplau's theory. Changes in the percentage of interaction assigned to the relationship phases along with a rating from the Relationship Form were compared over time to determine whether relationships progressed as predicted by Peplau. Findings of this study supported Peplau's theory. Implications for nursing practice and research are discussed.

House Calls↗

Siblings of a child with cancer.

A total of 21 healthy siblings were interviewed about their experiences when a brother or sister is diagnosed with cancer. Information about the illness, opinions about who should inform siblings, social support, specific worries and worst memories were studied, as well as perceptions of any differences in the way they were treated by their parents. A short General Impact Scale was developed to assess the extent to which the siblings felt their lives had been disrupted by the illness. Results on these measures were compared with scores on four dimensions of the Sibling Perception Questionnaire (Carpenter & Sahler 1991). Siblings who reported some positive effects as a consequence of the illness (they had become more empathic toward others, or valued life more) perceived their interpersonal relations to be more negatively affected, i.e. there were greater difficulties in their relationships with others especially their parents. Higher scores on communication were related to less of an impact of the illness on life generally. However, these siblings also reported heightened concerns that their brother or sister might die. The data suggested that siblings should have opportunities to talk about implications of the disease, especially worries about death, and more efforts should be made to prepare siblings for visits to hospital and seeing the sick child.

Adaptation, Psychological↗

Evaluating partnership working: lessons for palliative care.

Partnership working in palliative care is being increasingly promoted as the solution to poorly coordinated health and social care services. A key example is the UK National Institute for Clinical Excellence (NICE) guidance on supportive and palliative care. However, partnerships have costs in negotiating, developing and maintaining working relationships and translating these into successful outcomes, so may not always be the best or most effective method of service improvement. This article explores structural, procedural, financial, professional and legitimacy barriers to partnership working. We conclude that these five barriers could be sufficient to destroy emerging partnerships. Nowhere in the NICE guidance on supportive and palliative care are such barriers acknowledged. We suggest that current and projected palliative care partnerships should be critically evaluated against both process and outcome success criteria. Such evaluations must be integral to partnerships, to learn about what makes an effective palliative care partnership, and what affects partnerships have on patient care and outcomes. Partnerships may not be the panacea for issues of fragmentation, and should not be the only solution considered. Lessons should be learnt from the UK's promulgation of partnerships to ensure that these are used appropriately and only where patient benefit can be anticipated.

Delivery of Health Care↗

Research on nurse-patient relationships: problems of theory, problems of practice.

Research, theoretical and educational literature on interpersonal relations between nurses and patients has proliferated since the 1960s. This has generated a range of divergent accounts of what the nurse-patient relationship (NPR) ought to be; how this should be achieved; and how the NPR is constituted in practice. In this paper--through a selective review of the literature--the development of two contending perspectives on NPR and on nurse-patient interaction (NPI) characterized as technocratic and contextual, is discussed, and related to the increasingly problematic status of the relationship between nurses and patients in nursing theory and research.

Communication↗

Effects of communication with important social referents on beliefs and intentions to use condoms.

Data from a 1989 survey using the condom attitude and belief instrument with 310 clients from two sexually transmitted disease clinics identified significant social referents who influence condom-use intentions. They are sexual partner, father and friends. The present study found that communication with these referents had a positive net effect on beliefs about and intentions to use condoms. Implications applicable for intervention programmes to increase condom use are to promote talking about condoms between the sexual partners and important social referents and to develop such communication skills.

Adolescent↗

Quality of life from the point of view of Latin American families: a participative research study.

BACKGROUND: To date, little research has focused on what factors constitute a quality of life (QOL) among Latin American families with a member who is intellectually disabled. METHOD: Total 180 Latin American families cooperated in a participative research project. During 18 months, the families and a team exchanged information about their QOL by means of questionnaires and grids that the families analysed and completed at their homes. RESULTS: In Latin America, families attribute utmost importance to interpersonal relations and emotional well-being. In addition, results identified a number of QOL domains and indicators reflective of family-centred QOL among Latin American families. A tool with 42 indicators grouped in six areas was obtained. CONCLUSIONS: Quality of life is a concept that has meaning and structure which varies considerably from culture to culture. A topologic QOL model is presented to facilitate the cross-cultural understanding of the QOL construct.

Attitude↗

Expertizing of posttraumatic sexual disturbances in males.

An analysis has been performed of 95 expertises in men, who asked for compensation of after-effects in injury in their sex life. The regions most frequently affected were sexual organs, the head, the pelvis and the lower spine. Roughly one half of the examinees reacted strongly to the injury and its consequences. The most frequently reported symptoms were erectivity disturbances. The greatest subgroup consisted of men who had a rational attitude to an objective organic finding (about 38%). The second place is occupied by men in whom it was not possible to prove any somatic changes, but whose psychic reaction to injury was distinct and pronounced (about 31%). Roughly two out of three men reported a deterioration of their working capacity after injury and/or a disturbance of their interpersonal relations. Only 5% of the examinees underwent an expert examination during the first year following the injury. It is stressed that administrative procedures for damages should be performed with maximum speed especially in cases where there were no objectively proved after-effects.

Adult↗

Efficacy of 3-year psychiatric daycare treatment in patients with schizophrenia.

The present study investigated the efficacy of a 3-year psychiatric daycare (DC) program with regard to psychiatric symptoms and difficulties with daily living experienced by patients with schizophrenia. The subjects were 28 patients who met the diagnostic criteria from the 4th edition of the Diagnostic and Statistical Manual for schizophrenia and continued DC treatment for 3 years. The present study assessed participants at two points: at the start of DC and after 3 years, by evaluating socioeconomic factors and Brief Psychiatric Rating Scale (BPRS) scores. In addition, in order to measure difficulties with daily living, the Life Assessment Scale for the Mentally Ill (LASMI) and the Etoh Daycare Assessment Scale (ETODAS) developed at the Etoh Hospital, were used. Results indicated that no significant changes in socioeconomic factors or BPRS scores occurred during the 3-year period of DC treatment. However, over this period, mean scores (+/- standard deviation [SD]) for LASMI subcategories decreased from 1.6 +/- 0.8 points to 0.9 +/- 0.7 for daily living and from 1.7 +/- 0.8 to 1.2 +/- 0.7 for interpersonal relations, indicating significant improvement (P < 0.05). In addition, mean scores (+/-SD) for the ETODAS subcategories increased from 3.4 +/- 0.8 to 4.1 +/- 0.8 for expressiveness, from 3.3 +/- 0.9 to 4.0 +/- 0.8 for communication, from 3.1 +/- 0.6 to 3.6 +/- 1.0 for initiative within a group, and from 3.4 +/- 0.5 to 3.8 +/- 0.7 for cooperation in work activities, indicating significant improvement (P < 0.05). The present study suggests that DC can enable patients with schizophrenia to maintain their condition without worsening the psychiatric symptoms, and to improve their daily living skills, social skills in human relations, and work skills.

Activities of Daily Living↗