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Effect of uncertainty on depression in patients with newly diagnosed atrial fibrillation.

This cross-sectional survey study aimed to determine the effects of uncertainty on depression through the appraisal within the "uncertainty in illness" model. In 81 subjects with atrial fibrillation, individuals with greater symptom severity perceived more uncertainty. Uncertainty was appraised as a danger rather than an opportunity. While the appraisal of opportunity had a negative relationship with depression, the appraisal of danger was positively associated with depression. The indirect effect of uncertainty on depression through appraisal was supported by the empirical data on patients with atrial fibrillation. Helping patients to correctly interpret symptoms and to understand the effectiveness of treatment may modify and reduce their uncertainty so that uncertainty leading to worse health outcomes may be reduced.

Adaptation, Psychological↗

The lived experience of self-transcendence in gay men with AIDS.

This phenomenologic study described the structure of self-transcendence in eight gay men with AIDS. The men provided oral or written descriptions of experiences associated with feelings of increased interconnectedness with others, sense of well-being, and meaning and purpose in life. The data were analyzed using Colaizzi's phenomenologic technique. The men experienced self-transcendence in the three ways described by Frankl. Reaching out for help and helping others alleviated the men's sense of aloneness and isolation. Their acceptance of the closeness of death led to a sense of urgency to create a legacy and to participate only in activities that had meaning for them. Knowledge of these views and behaviors may help nurses to create a therapeutic exchange in which self-transcendent views are fostered in other gay men with AIDS.

Acquired Immunodeficiency Syndrome↗

Graduate nurses' experiences of interactions with professional nursing staff during transition to the professional role.

As new members of the nursing profession, graduate nurses (GNs), in their transition to the professional role, have a variety of experiences with registered nurses. These experiences give rise to diverse thoughts and emotional responses that may have a significant impact on nurses' own professional development and socialization to the professional role. Literature documenting GNs' perceptions and feelings regarding their orientation to the professional role is scarce. This study involved 16 nurses' descriptions of their own experiences, thoughts, and feelings that arose from interactions with nurse colleagues during their first year of professional nursing practice. There was a lack of consistency regarding the way in which GNs were assisted in this important transitional teaching and learning experience. Understanding GNs' perceptions of the process of transition to the professional role holds tremendous value for nursing education. This understanding could serve as a guide in the development of positive and appropriate orientation strategies as we strive to imbue nursing graduates with the professional values, attitudes, and behaviors that are essential in achieving outcomes reflective of quality patient care.

Adaptation, Psychological↗

The caring behaviors of the home health nurse and influence on medication adherence.

The purpose of this study was to determine if the caring behaviors of the home health nurse toward the patient influence the patient's medication adherence. The study focused on what effects the verbal and nonverbal caring behaviors of the nurse toward the patient have on the patient's medication adherence. How is the patient's perception of caring by the nurse related to his or her medication adherence? The study was conducted in a Midwestern home health agency over a 4-week period. Findings indicated an improvement in the use of verbal and nonverbal caring behaviors by the nurses with their patients. The patients perceived an increased use of these caring behaviors by the nurses with them. The patients' medication adherence and barriers to adherence improved. Other significant findings indicated that the verbal and nonverbal caring behaviors of the nurses and the patients' perception of the caring behaviors influenced and improved the patients' medication adherence by week 4.

Adult↗

Exercise behavior and related factors in career women - the case of a bank in Taipei City.

With the trend of premature aging of physiological functions on the rise and a variety of chronic diseases continuing to spread, health promotion has become the top concern among public health experts. Regular exercise plays a pivotal role in both health promotion and disease prevention. This study aims to investigate the exercise behavior of career women and related factors. The samples were drawn from the female employees of a bank in Taipei, totaling 361 persons, all aged between 20 and 56. The result shows that only 8.6 % of the respondents exercise regularly and that among the reasons for not doing any exercise, " Don ' t have time for it " tops the list. Self-efficacy in exercise is found to be the common factor for predicting both exercise regularity and total exercise amount. Exercise intervention programs thus must be developed on the basis of female self-efficacy with a " family-oriented " activity design. It is therefore suggested that employers promote exercise and encourage exercise behaviors to help enhance employee self-efficacy as well as employee health.

Adult↗

Contemporary smoking cessation.

BACKGROUND: Tobacco smoking is the single most preventable cause of death in the United States today. Oncologists are in a unique position to affect the health and economic burdens of smoking by encouraging cessation among their patients who smoke. METHODS: The authors describe and review the effectiveness of current smoking cessation interventions as well as strategies that can be used to encourage cessation among patients. Three types of smoking cessation interventions are described: minimal (or self-help) interventions, behavioral interventions, and pharmacotherapy. The effectiveness of combinations of these types of treatments is also discussed. RESULTS: Oncology professionals can improve their patients' chances for success by implementing various cost-effective and easily executed smoking cessation interventions. Advice from a physician to quit smoking has resulted in long-term quit rates of up to 10.2%, and nicotine transdermal patches, nicotine gum, inhalers, and nasal sprays are also effective. CONCLUSIONS: Oncologists are encouraged to adopt the "4As" treatment protocol recommended by the National Cancer Institute: ask patients about their smoking status, advise them to quit, assist by recommending pharmacotherapy, counseling, and psychosocial self-help materials, and arrange follow-up.

Behavior Therapy↗

Evidence for healing interventions with perinatal bereavement.

The purpose of this article is to explore the concept of perinatal grief and evidence-based healing interventions for it. The loss of a pregnancy or death of an infant causes profound grief, yet society has long minimized or ignored this grief, which is among the most painful of bereavement experiences. Throughout the last century, research on grief and the special needs of bereaved parents has changed the context of professional intervention from protective to supportive. The central focus of bereavement interventions is to assist families in healing by helping them make meaning of their losses. The use of symbols, spirituality, and rituals has been shown to help bring meaning. Research has shown that memories are key to healing, and that gender, age, and relationships bring different grief expressions and experiences. While children's understanding of loss and grief differs with developmental age, they should also be given the opportunity to participate in grief rituals and practices. Professionals who care for bereaved parents have a unique opportunity to offer support by validating their grief, facilitating rituals, providing mementos, and letting the bereaved tell their stories. While no intervention can bring back their beloved children, appropriate intervention can promote healing.

Adaptation, Psychological↗

Mothers' experience of helping young adults with traumatic brain injury.

PURPOSE: To describe mothers' experience of helping young adults with traumatic brain injury (TBI). DESIGN: Descriptive. METHODS: A convenience sample of participants from support groups for parents of young adults with TBI met the criteria of engaging in regular interaction or helping their children (aged 20 to 36 years). These young adults had suffered moderate or severe TBI from a motor vehicle collisions, sports-related injuries, or recreation-related injuries more than 6 months earlier. A descriptive phenomenological method was used. Three in-depth interviews were done with each mother over a 2-month period. Data were the mothers' perceptions, actions, and intentions pertaining to their experiences of helping the young adults. FINDINGS: Five phenomena that were structures of the experience were discerned, discussed with participants to obtain their feedback, and compared to the relevant literature. The five phenomena of the mothers' experiences were: reconnecting my child's brain, considering my child's safety, making our lives as normal as possible, dealing with our biggest problem, and advocating for my child. CONCLUSIONS: The mothers continued rehabilitation efforts with the young adults, even when only minimal services were available to support their efforts. Mothers needed interventions to enhance their knowledge, and they and the young adults with TBI needed expanded community services.

Activities of Daily Living↗

Patients' perspectives on ideal physician behaviors.

We incorporated the views of patients to develop a comprehensive set of ideal physician behaviors. Telephone interviews were conducted in 2001 and 2002 with a random sample of 192 patients who were seen in 14 different medical specialties of Mayo Clinic in Scottsdale, Ariz, and Mayo Clinic in Rochester, Minn. Interviews focused on the physician-patient relationship and lasted between 20 and 50 minutes. Patients were asked to describe their best and worst experiences with a physician in the Mayo Clinic system and to give specifics of the encounter. The interviewers independently generated and validated 7 ideal behavioral themes that emerged from the interview transcripts. The ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Ways that physicians can incorporate clues to the 7 ideal physician behaviors to create positive relationships with patients are suggested.

Attitude of Health Personnel↗

Grandparents in Japan: a three-generational study.

Grandparents in Japan believe that their status in the family is eroding. They want to be influential but social policy has not included education for their changing role. The purpose of this study was to identify strengths and needs of Japanese grandparents as perceived by three generations. Each generation completed a separate version of the Grandparent Strengths and Needs Inventory. Multivariate analysis of variance procedures were used to compare perceptions of 239 grandparents, 266 parents, and 274 school-age grandchildren from cities and small towns. Grandparents reported more satisfaction, greater success, and more extensive involvement in teaching than was observed by parents and grandchildren. Grandparents experienced greater difficulty, more frustration, and felt less informed to carry out their role than was reported by parents and grandchildren. Significant main effects that influenced responses about grandparent performance were generation, gender of grandchild, age of grandchild, generations living together, frequency of grandchild care by grandparent, and amount of time they spent together. Considerations were identified to improve grandparent behavior and guide the development of educational programs for them.

Aged↗

Suicide prevention strategies: a systematic review.

CONTEXT: In 2002, an estimated 877,000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated. OBJECTIVES: To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research. DATA SOURCES AND STUDY SELECTION: Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide. DATA EXTRACTION: Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented. DATA SYNTHESIS: Education of physicians and restricting access to lethal means were found to prevent suicide. Other methods including public education, screening programs, and media education need more testing. CONCLUSIONS: Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy. Ascertaining which components of suicide prevention programs are effective in reducing rates of suicide and suicide attempt is essential in order to optimize use of limited resources.

Antipsychotic Agents↗

Thinking of you: nonconscious pursuit of interpersonal goals associated with relationship partners.

The mere psychological presence of relationship partners was hypothesized to trigger interpersonal goals that are then pursued nonconsciously. Qualitative data suggested that people tend to pursue different interpersonal goals within different types of relationships (e.g., mother, best friend, coworker). In several studies, priming participants' relationship representations produced goal-directed behavior (achievement, helping, understanding) in line with the previously assessed goal content of those representations. These findings support the hypothesis that interpersonal goals are component features of relationship representations and that mere activation of those representations, even in the partner's physical absence, causes the goals to become active and to guide behavior nonconsciously within the current situation.

Adolescent↗

Randomized trial of a "talking computer" to improve adults' eating habits.

PURPOSE: To assess efficacy of an intervention delivered by an interactive, computer-controlled telephone system to improve individuals' diets. DESIGN: Randomized controlled trial. SETTING: Large multispecialty group practice. SUBJECTS: Two hundred ninety-eight adults who were both sedentary and had suboptimal diet quality. INTERVENTION: Weekly communication for 6 months via a totally automated, computer-based voice system. Among intervention group subjects, the system monitored dietary habits and provided educational feedback, advice, and behavioral counseling. Control group subjects received physical activity promotion counseling. MEASURES: Daily intake of fruits, vegetables, red and processed meats, whole fat dairy foods, and whole grain foods estimated from a food frequency questionnaire. RESULTS: Mean age 45.9 years, 72% women, 45% white, and 45% African-American. Among participants who completed diet assessments, compared with the control group, the intervention raised fruit intake a mean of 1.1 servings per day (95% confidence interval [CI] .4, 1.7). On a 0 to 100 global diet quality score combining all five food groups, intervention participants improved their mean score 9 (95% CI 4, 13) points more than in the control group. The intervention also raised dietary fiber intake 4.0 g/d (95% CI .1, 7.8) and decreased saturated fat, as a proportion of energy intake, by 1.7% (95% CI -2.7, -.7). CONCLUSIONS: This computer-based telecommunications dietary behavior intervention helped improve participants' overall diet.

Adult↗

Fat-related dietary behaviors of adult Puerto Ricans, with and without diabetes, in New York City.

OBJECTIVE: To assess the fat-related dietary behaviors of adult Puerto Ricans with and without diagnosed diabetes, living in New York City. DESIGN: A random-digit-dialing telephone survey was conducted following Behavioral Risk Factor Surveillance System procedures. Dietary behavior was assessed using a brief Fat-Related Diet Habits Questionnaire, in which higher scores indicated higher fat intake. SUBJECTS/SETTING: A total of 1,304 adult Puerto Ricans living in New York City were interviewed. Diabetes status was assessed using standard Behavioral Risk Factor Surveillance System questions. STATISTICAL ANALYSES PERFORMED: Weighted analyses using SUDAAN software for complex surveys were done, and t tests were used to assess differences in mean fat-related dietary score by sociodemographic and health characteristics. Age-adjusted least-squared means were used to compare scores between those with and without diabetes. Linear regression was used to model characteristics associated with fat-related dietary score. RESULTS: Fat-related dietary score was lower among those with diabetes and varied by population and health characteristics. Age-adjusted scores were significantly lower for those with diabetes who were younger, less educated, obese, or physically active. In the regression model, family history, weight, and exercise interacted with diabetes status. Those with diabetes were significantly more likely to modify meat consumption practices (eg, remove skin or trim fat) to reduce fat compared with those without diabetes. CONCLUSIONS: New York City Puerto Ricans with diabetes are somewhat more likely to engage in behaviors to reduce fat compared with those without diabetes. Targeted, culturally sensitive nutrition education and counseling emphasizing lower-fat food choices and other fat-reducing behaviors can help reduce risk and control diabetes. Education messages should be tailored to the individual's diabetes status and other health and sociodemographic characteristics.

Adolescent↗

Symptoms of pervasive developmental disorders as observed in prediagnostic home videos of infants and toddlers.

OBJECTIVES: The objectives of this study were (1) to show prediagnostic abnormalities in social and communicative behaviors on home videos of children who later received a diagnosis of one of the pervasive developmental disorders (PDD) and (2) to demonstrate that prediagnostic abnormalities in social and communicative behaviors for children with PDD not otherwise specified will be less prominent than those in children with autistic disorder but still distinguishable from those of typically developing peers. STUDY DESIGN: Parents of children with PDD each submitted home videos of social events that were made when their child was between the ages of 12 and 30 months, before diagnosis. Two independent observers, unaware of the subjects' diagnoses or purpose of the study, scored the rates of specific anomalies in social and communicative behavior. Two additional observers scored the percentage of time the children were engaged socially or with objects. Data from the experimental group were compared with those of 25 age-matched children with no developmental disabilities. RESULTS: Significant differences were found between the rates of social engagement and 8 of the 25 specific behaviors of the children in whom PDD was later diagnosed and those of the typical children. The children later given the diagnosis of PDD not otherwise specified had mean frequencies of some social interactions and communicative skills that fell between those of children later given the diagnosis of autistic disorder and those of children with typical development. CONCLUSION: In our sample children in whom PDD was later diagnosed could be differentiated from their typically developing peers on the basis of specific anomalies noted in their social and communicative behaviors, especially joint attention. In our sample children with PDD not otherwise specified could have been further differentiated on the basis of the rates of social interaction. Careful assessment of social interaction and communicative behaviors may help to identify children with PDD before the age of 30 months.

Autistic Disorder↗

Enhancing the quality of supportive supervisory behavior in long-term care facilities.

The practices of managers and registered nurses (RNs) in long-term care facilities are frequently ineffective in assisting the licensed practical nurses (LPNs) and healthcare aides (HCAs) whom they supervise. Little research exists that examines the area of supportive relationships between nursing staff and supervisors in these settings. The purpose of this study was to gather data that could improve management practices in long-term care residential facilities and enhance the quality of the supervisory relationships between supervisors (nurse managers and RNs) and care providers (HCAs and LPNs) in these settings. The study also identified factors that influence the supervisors' ability to establish supportive relationships with care providers. The challenges and barriers to nurse managers and leaders related to enacting supportive behaviors are discussed as well as their implications for long-term care settings.

Adult↗

On inferring one's beliefs from one's attempt and consequences for subsequent compliance.

D. J. Bem (1967, 1972) has suggested that a person may infer his or her beliefs from his or her actions. With his information-processing viewpoint, D. J. Bem proposed that individuals, by observing their past behaviors, may draw information for assessing their beliefs about themselves. There is a question, however, about the mechanism of self-perception when there is inconsistency between one's attempt to realize an intended goal and the outcome of the action. In a series of field studies, participants who had unsuccessfully tried to help a stranger were more willing to comply with a relatively large request made later. Implications for self-perception theory as well as for enhancing susceptibility to influence techniques are discussed.

Adult↗