Hypertension associated factors and blood pressure among adolescent workers

The aim of this study was to identify hypertension associated factors (AF) and verify blood pressure (BP) levels among adolescent workers. Interviews were conducted with 193 working adolescents--135 men and 58 women between 16 and 18 years. After five minutes in seated position, their arm circumferences were measured and their BP was determined using correct (CCW) and standard (SCW) cuff widths. The values were related to AF. BP was, in average, 105.2/60.9 mmHg (CCW) and 101.0/57.9 (SCW- p < 0.05). Among the AF found, only skin color and alcoholic drinking were associated to BP elevation, also noted in male adolescents. When using CCW, more hypertensive and borderline adolescents were found than using SCW. All of them had at least one AF. It can be concluded that there are several hypertension AF among this population, and some of them are already causing BP elevation. Studies such as this should be made frequently because adolescent blood pressure levels can predict hypertension in adulthood.     

老年高血压病人血压控制不佳的护理干预

高血压病人是老年人常见的心血管疾病之一,也是引起脑卒中的主要危险因素,故有效控制血压,保持血压稳定会降低这种危险性[1],2005年6月-2006年7月对老年科96例血压控制不佳的住院病人实施护理干预,效果满意,现报道如下.     

Factors associated with glycemic control and diabetes self-care among outpatients with schizophrenia and type 2 diabetes

We investigated the influence of the severity of schizophrenia on diabetes self-care and glycemic control among outpatients with schizophrenia and diabetes. We conducted interviews with 38 participants and reviewed their clinical charts. The mean hemoglobin A1c (HbA1c) level in the full study population was 7.65%. There was no difference in the HbA1c level between two groups of subjects classified by the severity of schizophrenia. Some diabetes self-care indicators were significantly lower in patients with high Brief Psychiatric Rating Scale scores (P < .05). Although psychotic symptoms do not appear to affect glycemic control, psychotic symptoms might affect diabetes self-care behaviors in people with schizophrenia.     

北京市门诊高血压患者家庭自测血压的现况调查及其影响因素

目的调查北京市门诊高血压患者家庭自测血压情况、影响因素以及存在问题。方法对北京市某三甲医院心内科门诊就诊的535名高血压患者进行调查,发放自制调查问卷,收集家庭自测血压的相关信息,对问卷内容进行统计分析。结果被调查患者的家庭血压计持有率为90.3%,进行家庭自测血压的患者占63.0%,其中每日家庭测量率为22.2%,每周测量率为19.8%,每月测量率为20.9%。采用家庭自测血压相关因素的单因素分析发现文化程度、高血压病程、是否持有血压计、血压是否达标是影响家庭自测血压的主要因素。结论北京高血压患者血压计持有率与发达国家已无明显区别,甚至更高,但使用正确性和规范性有待提高。需关注影响家庭自测血压的因素,优化血压管理。     

Self-reported prevalence and factors associated with nonadherence with glaucoma medications in veteran outpatients

Objective: The purpose of the current study was to determine the self-reported prevalence of and factors associated with nonadherence with glaucoma medications in veteran outpatients.Methods: This survey study was conducted at a Veterans Affairs (VA) clinic. A survey was administered to patients with glaucoma. We calculated the percentage of self-reported adherence with glaucoma medications in each patient. Logistic regression was used to assess whether patient characteristics and difficulties with using glaucoma medications were related to patients' reporting that they were <100% adherent with their glaucoma medications in the previous week.Results: The survey was completed by 141 patients (men, 91.5%; mean [SD] age, 70.22 [11.60] years [range, 37–93 years]; black race, 45.4%; white race, 44.0%; “other” or data unavailable, 10.6%). Nonwhite patients were significantly less adherent in the previous week than were white patients (27.0% vs 11.3%; P < 0.05). A total of 67.4% patients reported ≥1 difficulty in using their glaucoma medications. The 3 most commonly reported difficulties were “drops fall on cheek” (29.1%), “too many drops come out” (20.6%), and “hard to read print” (17.0%). A total of 19.1% of patients self-reported using <100% of their glaucoma medications in the previous week. The number of difficulties reported was significantly associated with reporting being <100% adherent in the previous week (P<0.05).Conclusion: In this small sample of VA patients with glaucoma, adherence to glaucoma medications could be improved, especially among those who reported difficulties using their medications and those who were nonwhite.     

Psychosocial factors associated with pressure sores.

To determine if psychosocial factors, not purely mechanical aspects, play an important part in the incidence of pressure sores, 141 subjects were tested on 3 psychosocial measures. Results indicate that differences exist among groups in pressure sore history and psychosocial measures. Contrary to the expectations of a mechanical skin problem model, quadriplegics as a group (rather than paraplegics) had a history of fewer pressure sores. Two variables, the subject's responsibility in skin care (RESPON) and his satisfaction with the activiities of life (SATIS), were significantly associated with the incidence of decubitus ulcers. The combination of RESPON, SATIS, and the total positive score from the Tennessee Self-Concept Scale in multiple linear regression accounted for (1) 26% of the pressure sore history in the total sample, (2) 40% in the paraplegic group, (3) 69% in the paraplegic with help group, and (4) 41% in the paraplegic without help group. The histories in the quadriplegic groups and subgroups did not show reliable associations with the 3 variables. SATIS contributed most in accounting for the incidence of pressure sores. The level of injury and these psychosocial factors are thus related to the incidence of pressure sores.     

Cognitive dysfunction is associated with poor diabetes control in older adults

OBJECTIVE: To evaluate the association between cognitive dysfunction and other barriers and glycemic control in older adults with diabetes. RESEARCH DESIGN AND METHODS: Patients over the age of 70 years presenting to a geriatric diabetes clinic were evaluated for barriers to successful diabetes management. Patients were screened for cognitive dysfunction with the Mini Mental State Examination (MMSE) and a clock-drawing test (CDT) scored by 1) a method validated by Mendez et al. and 2) a modified CDT (clock in a box [CIB]). Depression was evaluated with the Geriatric Depression Scale. Interview questionnaires surveyed activities of daily living (ADLs) and instrumental ADLs (IADLs), as well as other functional disabilities. RESULTS: Sixty patients (age 79 +/- 5 years, diabetes duration 14 +/- 13 years) were evaluated. Thirty-four percent of patients had low CIB (< or =5), and 38% of patients had low CDT (< or =13). Both CIB as well as CDT were inversely correlated with HbA(1c), suggesting that cognitive dysfunction is associated with poor glycemic control (r = -0.37, P < 0.004 and r = -0.38, P < 0.004, respectively). Thirty-three percent of patients had depressive symptoms with greater difficulty completing the tasks of the IADL survey (5.7 +/- 1.7 vs. 4.6 +/- 2.0; P < 0.03). These older adults with diabetes had a high incidence of functional disabilities, including hearing impairment (48%), vision impairment (53%), history of recent falls (33%), fear of falls (44%), and difficulty performing IADLs (39%). CONCLUSIONS: Older adults with diabetes have a high risk of undiagnosed cognitive dysfunction, depression, and functional disabilities. Cognitive dysfunction in this population is associated with poor diabetes control.     

Intrinsic factors associated with pressure sores in elderly people

As a preliminary to a larger, prospective study of intrinsic factors associated with pressure sore development in a population of elderly hospital in-patients, this retrospective study of patients who had participated in an earlier, unrelated study was completed. The results of biochemical and haematological analyses from admission, together with details of nursing care, were obtained from medical and nursing notes, and analysed in relation to the condition of the pressure areas of each patient, which had been documented by a single observer throughout the period of study. The relationships between intrinsic factors such as serum protein concentration and systolic blood pressure, and the presence of, or tendency to develop pressure sores is examined and discussed in the light of a need for more specific and sensitive risk assessment tools.     

Improved blood pressure control with a physician-nurse team and home blood pressure measurement

OBJECTIVE: To assess whether a physician-nurse team model could improve long-term hypertension control rates by active intervention and modification of antihypertensive drug regimens based on home blood pressure (BP) measurements. PATIENTS AND METHODS: This study consisted of patients referred to a hypertension specialty clinic between July 1999 and June 2002 for the evaluation and management of uncontrolled hypertension. Patients were evaluated initially by a physician. A treatment plan was designed and implemented subsequently by a hypertension nurse specialist. Each patient was given an automated digital home BP monitor and requested to provide 42 BP readings taken during 7 days at intervals of 1, 3, 6, 9, and 12 months after dismissal from the clinic. The mean of these weekly values was reviewed by the physician-nurse team, and the treatment regimen was adjusted to achieve a goal BP of less than 135/85 mm Hg. RESULTS: One hundred six consecutively referred patients were enrolled in the study (mean+/-SD age, 64+/-14 years; 58% female; baseline BP, 156+/-16/85+/-11 mm Hg). Ninety-four patients submitted BP data after 1 month, and 78 patients completed the entire 12-month study period. Overall, mean BP decreased to 138+/-17/78+/-8 mm Hg at 1 month and to 131+/-9/75+/-7 mm Hg at 12 months (P<.01 vs baseline). The percentage of patients who achieved BP control to less than 135/85 mm Hg increased from 0% at baseline to 63% at 12 months. Intensification of antihypertensive drug therapy was required, on average, in 24% of patients at each study interval. The mean number of drugs increased from 1.2 at baseline to 2.0 at 12 months (P<.01). CONCLUSION: The use of home BP measurement by a physician-nurse team has the potential to significantly improve long-term hypertension control rates in a geographically dispersed patient population. This model should reduce both cost and inconvenience associated with the treatment of hypertension.     

Race-related differences in metabolic control among adults with diabetes.

The effect of race on differences in metabolic control was examined in patients with non-insulin-dependent (NIDDM) and insulin-dependent (IDDM) diabetes mellitus. Data were collected on HbA1c, age, duration of diabetes, age at onset, family function, stress, body mass index, waist/hip ratio, total cholesterol, insulin dose, diet, and physical activity. Among those with NIDDM, black patients had significantly higher HbA1c levels than their white counterparts. This difference persisted after adjustment for covariates. Among patients with IDDM, black subjects were found to have higher HbA1c levels, body mass index, and total cholesterol levels than their white counterparts. After correction for diabetes duration, relative insulin dose, physical activity, body mass index, and cholesterol, black women had significantly higher HbA1c levels than black men, white men, or white women. We conclude that race and sex differences do affect the metabolic control of patients with diabetes mellitus.     

高血压患者门诊药物治疗血压达标的影响因素

目的 了解现实治疗状况中,对高血压患者在门诊药物治疗中,影响血压控制达标的相关因素.方法 对1012例来本院申请办理医疗保险高血压慢性病门诊的患者进行回顾性调查,分别记录患者的年龄、性别、患病年限、历史最高血压、当前血压、当前用药种类、随诊科室等情况.并统计达标率,分析在各科室或机构就诊患者的达标率;分析达标患者中各种药物的使用比例及联用情况;应用Logistic回归分析得出门诊高血压患者长期血压控制达标的影响因素.结果 患者平均年龄（66.2±10.9）岁,男357例,女655例,平均高血压患病时间（11.1±9.7）年,总体达标率34.4％,达标患者主要集中在心血管专科就诊,占71.2％;该人群中以钙离子拮抗剂（CCB）的使用率最高,1、2、3级高血压患者的使用率分别为62.1％、88.9％、80.8％;β受体阻滞剂（β-B）次之,分别为37.9％、58.3％、60.3％.1级血压达标患者51.7％单药治疗;随着血压水平升高,达标患者联合治疗比例增高：2、3级高血压患者分别为76.4％、85.9％;在2种药物组合中,最常被选用的联合是CCB和β-B,占44.4％,其次是CCB和血管紧张素受体拮抗剂（ARB）,占15.9％.Logistic回归分析显示：在心内科专科随诊、使用CCB是血压达标的独立促进因素（OR和P值分别为：14.49,0.019;1.95,0.005）.既往最高收缩压是影响达标的不利因素（OR =0.98,P=0.017）.结论 要高血压患者门诊药物治疗血压达标,应该定期在心血管专科门诊随诊以调整治疗方案,中度以上高血压患者应采取联合治疗,并应用以CCB为基础的联合治疗方案.     

Ethnic differences in risk factors associated with genital human papillomavirus infections

This study was a cross-sectional analysis of different risk and cofactors for genital human papillomavirus (HPV) infection among 302 women in four ethnic groups at 10 clinic sites Ethnicity, rather than HPV status, accounted for most of the differences among the groups on five risk factors age at first sex, number of lifetime sexual partners, number of partners' sex partners, number of 'once only' sex partners, and number of 'long-term' sexual relationships There were also ethnic differences in three of four cofactors, which may contribute to progression of HPV infections, namely, age when women began taking oral contraceptives and duration of use, number of years smoked cigarettes, and number of other sexually transmitted diseases Women with more than four lifetime sex partners, more than two 'once only' sex partners, and/or women who took oral contraceptives for more than 4 years had a higher prevalence of HPV infection Major risk and cofactors for HPV infection of each ethnic group are described and compared with other HPV studies     

Rural-urban differences in educational attainment among registered nurses: Implications for achieving an 80% BSN workforce

BackgroundMultiple professional organizations and institutes recommend the Bachelor of Science in Nursing (BSN) degree as a minimum standard for registered nurse practice. Achieving this standard may be particularly challenging in rural areas, which tend to be more economically disadvantaged and have fewer opportunities for higher educational attainment compared to urban areas.PurposeOur primary objective was to provide updated information on rural-urban differences in educational attainment. We also examined rural-urban differences in employment type, salary, and demographics among registered nurses in different practice settings.MethodsData were obtained from the 2011–2015 American Community Survey (ACS) Public Use Microdata Sample (PUMS). The sample included registered nurses (RN) between the ages of 18–64 years (n = 34,104) from all 50 states. Chi-square tests, t-tests, and multivariable logistic regression were used to examine the relationship between rurality and BSN preparedness and salary across practice settings.ResultsUrban nurses were more likely to have a BSN degree than rural nurses (57.9% versus 46.1%, respectively; p < 0.0001), and BSN preparedness varied by state. In adjusted analysis, factors in addition to residence associated with BSN preparation included age, race, and region of the country. Differences in wages were experienced by nurses across practice settings with urban nurses generally earning significantly higher salaries across practice settings (p < 0.0001).ConclusionsStrategies to advance nursing workforce education are needed in rural areas and may contribute to improved care quality and health outcomes.     

门诊老年压力性损伤患者创面感染发生情况及危险因素分析

目的 分析门诊老年压力性损伤患者创面感染发生情况及相关危险因素。方法 对110例门诊老年压力性损伤患者创面感染情况进行调查,并收集患者的一般资料及压力性损伤创面的基本情况,分析压力性损伤创面感染发生的危险因素。结果 门诊老年压力性损伤患者创面感染的发生率为27.3%。回归分析结果表明糖尿病、水肿、创面持续时间是压力性损伤患者创面感染发生的危险因素,而之前经过正规治疗是其保护性因素。结论 创面感染是压力性损伤患者常见的并发症。既往有糖尿病、存在水肿情况及创面持续时间长(≥1个月)的压力性损伤患者是创面发生感染的高危人群。     

Causal relationships among factors associated with cancer-related fatigue

PurposeThis study was conducted to develop and verify a comprehensive model, which illustrates the dynamic causal relationships between fatigue and its associated factors in cancer patients.MethodThe subjects were 110 in- or out-patients with various types of cancer being treated at a University Hospital, Incheon, South Korea. The comprehensive model consists of physical distress, sleep-related, physiologic, psychological distress, physical performance, and exercise factors.ResultsPsychological distress had a significant direct effect on physical distress, and 81% of the variance in physical distress was explained by psychological distress. While psychological distress showed to have a significant total effect (the sum of direct effects of psychological distress and indirect effects through its relationship with physical distress) on fatigue, it was not found to have a significant direct effect on fatigue. Only exercise had a significant direct effect on fatigue and 70% of fatigue variance was explained by exercise alone. All remaining factors were not found to have significant direct effects on fatigue.ConclusionsThe hypothetical model was well suited to explain cancer-related fatigue. Our result indicates that psychological distress should be relieved in combination with a strategy to reduce physical distress in order to obtain better outcomes with respect to cancer-related fatigue. Only exercise had a significant direct effect on fatigue. In terms of the nursing implications, the proposed model can help oncology nurses better understand cancer-related fatigue and assess presence of correctable correlates. This model can be a future framework when developing intervention strategies for cancer-related fatigue.