Factors associated with sleep disturbance in women of Mexican descent

heilemann m.v., choudhury s.m., kury f.s. & lee k.a. (2012)?Factors associated with sleep disturbance in women of Mexican descent. Journal of Advanced Nursing68(10), 2256-2266. ABSTRACT: Aims. The aims were to identify the most useful parameters of acculturation in relation to self-reported sleep disturbance and describe risk factors for sleep disturbance in women of Mexican descent. Background. Little is known about acculturation as a factor for poor sleep in the context of other personal factors such as income or sense of resilience or mastery for Latinas in the United States. Design. This study was a secondary analysis of cross sectional survey data. Methods. Personal factors were incorporated into a modification of the Conceptual Framework of Impaired Sleep to guide our secondary analysis of self-reported sleep disturbance. Data were collected from a convenience sample of 312 women of Mexican descent of childbearing age (21-40?years) located in an urban California community were collected and previously analysed in relation to depressive symptoms and post-traumatic stress disorder. The General Sleep Disturbance Scale (in English and Spanish) was used to assess sleep disturbance. Data was collected in 1998 from September through December. Results. Early socialization to the United States during childhood was the most useful acculturation parameter for understanding self-reported sleep disturbance in this sample. In a multivariate regression analysis, three factors (higher acculturation, lower income and higher depressive symptoms) were statistically significant in accounting for 40% of the variance in sleep disturbance. Conclusion. When low income Latinas of Mexican descent report sleep problems, clinicians should probe for environmental sleep factors associated with low income, such as noise, over-crowding and exposure to trauma and violence, and refer the woman to psychotherapy and counselling rather than merely prescribing a sleep medication.     

Barriers to activation of the rapid response system

Background

The rapid response system (RRS) has been widely implemented in the US. Despite efforts to encourage activation of the RRS, adherence to activation criteria remains suboptimal. Barriers to adherence to RRS activation criteria remains poorly understood.

Objective

To identify barriers associated to activation of the RRS system by clinical staff.

Methods

Physicians and nurses on the medical and surgical wards of a New York City community hospital were surveyed to identify barriers to six criteria for activation of the RRS. A paper questionnaire was disseminated. We assessed familiarity with, agreement with, and recognition of perceived benefit of the RRS calling criteria using a Likert scale. Self-reported adherence to RRS activation was also measured on a Likert scale. Logistic regression was used to assess the association between the barriers and the six RRS criteria.

Results

Sixty eight physicians and 16 nurses completed the survey; response rates were 59% and 35%, respectively. Self-reported adherence rate was ≤25% for the six criteria. We observed that as the familiarity with, agreement with, and perceived benefit of activating the RRS increases, the self-reported adherence also increases.

Conclusions

Adherence to activation of RRT based on the six criteria measured is low. As familiarity with, agreement with, and perceived benefit of the RRS activating criteria rise, self-reported adherence rates increase, with familiarity having the greatest impact. These results can be used to develop tailored interventions to increase adherence to RRT activation in health care institutions.     

Acculturation level and postpartum depression in Hispanic mothers

PURPOSE: Perinatal health outcomes for Hispanic women are associated with acculturation. The purpose of this study was to explore the relationship between acculturation levels and postpartum depressive symptomatology and diagnosed postpartum depression among Hispanic subgroups. STUDY DESIGN AND METHODS: The Postpartum Depression Screening Scale and the Short Acculturation Scale were used in the two phases of data collection. Phase 1 and 2 samples consisted of 377 and 150 Hispanic mothers, respectively. Puerto Rican mothers showed higher levels of acculturation than Mexican and other Hispanic women. A DSM-IV diagnostic interview (SCID) was used to establish a diagnosis of depression. Hierarchical regression analyses were used to study the unique relationships between ethnicity, depressive symptomatology, diagnosed depression, and acculturation. RESULTS: There was no consistent relationship between acculturation and postpartum depression. Significant predictors of elevated postpartum depressive symptoms in Hispanic mothers were Puerto Rican ethnicity and cesarean delivery. Single marital status was a significant risk factor for postpartum depression. A limitation of the study was use of language as the sole criterion measure for acculturation. Acculturation is a complex construct with problematic measurement that needs greater refinement to facilitate research in which it is used as a variable. CLINICAL IMPLICATIONS: Hispanic mothers are a heterogeneous group and should not be treated as a homogeneous group. Subgroups of Hispanic mothers may not have the same level of acculturation or the same level of postpartum depressive symptomatology.     

Body mass index estimates using a categorical body weight variable: A cross-sectional secondary data analysis

BackgroundSelf-reported weight data have been considered questionable because of under- or over-reporting trends and stigma, especially among females.ObjectivesThis study aimed to evaluate the quality of self-reported categorical weight information used to determine body mass index (BMI) groups among females.DesignCross-sectional secondary data analysis.SettingsThis study used two datasets: a nurse survey of the Nurses Worklife and Health Study (NWHS) in the 2 US states, and the 2003–2004 National Health and Nutrition Examination Survey (NHANES).ParticipantsThis analysis included 2203 female nurses in the NWHS and 606 female participants in the NHANES, all of whom aged 22–83 years and were currently employed with at least a college education.MethodsBMI groups created using self-reported categorical weight data were compared to those derived from continuous weight responses and to the gold standard: scale measured weight data.ResultsWhen using the median values of each weight category, similar distributions of BMI groups were found to those obtained from continuous self-reported responses and direct scaled measures of weight. The groupings derived from the BMI median estimates demonstrated good agreement with those obtained from the directly scaled BMI data and good criterion/construct validity.ConclusionsBMI-based weight groups derived from self-reported categorical weight responses demonstrated good psychometric properties when the median value was used to calculate the BMI, and may promote more complete responding, especially among women.     

Work status and chronic low back pain: exploring the International Classification of Functioning, Disability and Health

PURPOSE: Exploring which variables are related to work status in patients with chronic low back pain (CLBP), classified according to the International Classification of Functioning, Disability and Health (ICF). METHOD: Ninety-two patients with CLBP filled out questionnaires inquiring after health status, impairments in body functions/structures, limitations in activities of daily living (ADL), participation in work, environmental and personal factors. Additionally, patients performed tests to measure physical fitness and performance of work-related activities. Univariate analyses were performed to investigate whether differences exist between working and non-working patients. Logistic linear regression analysis was performed to explain work status from the variables of functioning. RESULTS: Non-working patients had a lower self-reported physical and mental health, lower physical fitness, more self-reported limitations in ADL, lower education, more depressive symptoms and higher psycho neuroticism than working patients. Self-reported physical and mental health and educational level correctly classified 84.5% of the patients as working or non-working. Performance of work-related activities was not significantly related with work-status. CONCLUSIONS: The relation between work status and CLBP is multidimensional, as was illustrated by using the bio-psychosocial model of the ICF. Patients with a low educational level, a low self-reported physical or mental health were more likely to be non-working. Self-reported limitations and physical and mental health are more important in explaining work status than objective measurements of performance.     

Emotional well-being in a person with dementia

Self-reported mood and observations of affect are often used as indicators of emotional well-being. The purpose of this case study was to (a) describe the self-reported mood and affective pattern of an older man with severe cognitive impairments, (b) assess consistency in his responses to mood state, (c) compare mood pattern to premorbid personality, and (d) determine the concordance between self-reported mood and observed affect. Observations of mood and affect were taken three times per day for 35 days. There was concordance between self-reported mood and observed affect. The participant was consistent in his responses to mood 75% of the time. The pattern of self-reported mood reflected the participant's long-standing personality traits of extraversion and neuroticism. Results, although not generalizable, demonstrate the need to consider the perspective of the person with dementia when addressing quality-of-life issues in research and practice.     

"How deeply hypnotized did i get?" Predicting self-reported hypnotic depth from a phenomenological assessment instrument

Procedures for estimating hypnotic depth have been used for more than 70 years. This study predicted self-reported hypnotic depth from the phenomenological and behavioral variables of the Phenomenology of Consciousness Inventory-Hypnotic Assessment Procedure (PCI-HAP). Participants were divided into 2 groups; 1 was used to generate regression equations, and the other group was used for cross-validation. Both imagery vividness during hypnosis (imagoic suggestibility) and the PCI pHGS measure of hypnotic depth (hypnoidal state) accounted for most of the variance in self-reported hypnotic depth. The above results, further supported by correlational and 3-D visual analyses, are consistent with other researchers' observations that ratings of hypnotic depth are a function of: (a) alterations in subjective experience, and (b) the perception of responsiveness to suggestions. The findings are also congruent with J. Holroyd's hypothesis that suggestibility and altered-state effects interact to produce hypnotic effects.     

Obesity as a confounding health factor among women with mobility impairment

PURPOSE: To examine the relationships between self-reported height and weight and factors associated with disabilities that impair mobility among adult women. DATA SOURCES: Survey data were gathered from a convenience sample of 83 women with disabilities at community events targeting the disabled population. Height, weight, and factors associated with their disabilities were reported on a demographic questionnaire. Body mass index (BMI) was estimated using a conversion table and the self-reported height and weight of each participant. CONCLUSIONS: The average self-reported weight was 168.3 lb. Only 38% of the women fell into the normal range on estimated BMI, but 62% of the women fell into the categories of overweight or obese. The incidence of overweight and obesity exceeded that reported for the general population of women in a national sample X2 = 6.48, p = 03, 2 df). Self-reported weight was positively correlated with the number of comorbidities reported by the women (r = .419, p < .0001). IMPLICATIONS: The issue of obesity is an important problem facing women with disabilities. Women who have mobility limitations need to be weighed periodically, and strategies should be devised for weight management, including both dietary plans and appropriate exercise regimens given their limitations.     

Maternal and Paternal Parenting, Acculturation, and Young Adolescents'' Psychological Adjustment in Korean American Families

PROBLEM: Maintaining healthy psychological adjustment may be more complicated for Korean American young adolescents than for their European American counterparts. Korean American families live in two cultures and the issue of acculturation challenges their parenting, which is a critical factor for young adolescents' psychological adjustment. METHODS: Hierarchical multiple regressions were used to analyze 106 family data (young adolescents, mothers, and fathers) on parenting (acceptance-rejection and behavioral control), acculturation (integration, assimilation, separation, and marginalization), and young adolescents' psychological adjustment. FINDINGS: Only young adolescents' reports of maternal and paternal acceptance-rejection were related to their report of psychological adjustment. However, maternal acculturation moderated the relation between mothers' reports of maternal acceptance-rejection and behavioral control and young adolescents' report of their psychological adjustment. CONCLUSIONS: Parental acceptance-rejection is related to young adolescents' psychological adjustment when adolescents perceive themselves as accepted or rejected by parents. The relation between mothers' report of maternal acceptance-rejection and behavioral control and adolescents' psychological adjustment needs to be considered within the context of maternal acculturation.     

Medical and legal confusion surrounding gamma-hydroxybutyrate (GHB) and its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD)

BACKGROUND: Gamma-hydroxybutyrate (GHB) is used as a recreational drug, with significant associated morbidity and mortality; it is therefore a class C drug under the Misuse of Drugs Act (1971). However, its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD) remain legally available despite having similar clinical effects. AIM: The aim of this study was to determine whether the relative proportions of self-reported ingestions of GHB or its precursors GBL and 1,4BD were similar to those seen in analysis of seized drugs. DESIGN AND METHODS: Retrospective review of our clinical toxicology database to identify all cases of self-reported recreational GHB, GBL and 1,4BD use associated with ED presentation in 2006. Additionally all seized substances on people attending local club venues were analysed by a Home Office approved laboratory to identify any illicit substances present. RESULTS: In 2006, there were a total of 158 ED presentations, of which 150 (94.9%) and 8 (5.1%) were GHB and GBL self-reported ingestions respectively; 96.8% (153) were recreational use. Of the 418 samples seized, 225 (53.8%) were in liquid form; 85 (37.8%) contained GHB and 140 (62.2%) contained GBL. None of the seized samples contained 1,4BD and there were no self-reported 1,4BD ingestions. CONCLUSION: Self-reported GHB ingestion was much more common than GBL ingestion, whereas GBL was more commonly found in the seized samples. These differences suggest that GBL use may be more common than previously thought and we suggest that there should be further debate about the legal status of the precursors of GHB.     

Clinical assessment of ankle injury outcomes: case scenario using the foot and ankle ability measure

PATIENT SCENARIO: A 20-y-old male Division 1 college basketball player sustained a grade 2 inversion ankle sprain during preseason that is preventing him from practicing and competing. CLINICAL OUTCOMES ASSESSMENT: The Foot and Ankle Ability Measure (FAAM) was administered to the injured athlete as an evaluative tool to provide the clinician with valuable subjective information on the patient's self-reported function. The FAAM consists of 2 subscales: the activities of daily living (ADL) subscale and the sports subscale. Together the 2 subscales contain 29 questions (21 questions on the ADL and 8 on the sports subscale), which assess self-reported function and disability in the foot and ankle. CLINICAL DECISION MAKING: The addition of the self-reported functional measures provides the clinician with more quantitative data to make clinical decisions than is possible with typical clinical exams. Self-reported functional assessments should not replace thorough clinical examination or sound clinical judgment; instead they should be an adjunct to them. CLINICAL BOTTOM LINE: In addition to our objective assessment tools, the FAAM provides clinicians with a tool that can be used to assess function and disability through our patients' self-reported responses. When used for evaluative purposes the FAAM can measure an individual's changes in function and disability over time.     

Self-reported Exhaustion is Associated with Small Life Space in Older Adults with Mild Cognitive Impairment

[Purpose] Older adults experience exhaustion-induced health problems, such as poor physical function and low physical activity levels. The associations between self-reported exhaustion and physical function and activity are not clear in older adults with mild cognitive impairment (MCI). The aim of this study was to investigate the relationships between self-reported exhaustion and physical function and activity in older adults with mild cognitive impairment. [Subjects] A total of 356 older adults with mild cognitive impairment (mean age = 71.6 ± 0.3 years, 50.8% women) were included in this study. [Methods] Self-reported exhaustion was identified by one item from the Study of Osteoporotic Fractures index. Gait speed, gait endurance, and life space were also assessed. [Results] Sixty-two participants reported having exhaustion, giving a 17.4% prevalence of self-reported exhaustion among these individuals. Logistic regression analysis showed that the Life-Space Assessment score was the only parameter significantly independently associated with exhaustion status (adjusted odds ratio 0.97, 95% confidence interval 0.95–0.99). [Conclusion] These results suggest that self-reported exhaustion is associated with life space. Future research is needed to identify ways for older people with MCI to improve their exhaustion status.Key words: Mild cognitive impairment, Self-reported exhaustion, Life space     

Accuracy of Children's Self-Reported Adherence to Treatment

Purpose: To examine the relationship between self-reported and electronically monitored adherence to a recommended asthma treatment and to assess the accuracy of the diary data reported by school-age children.
Design: A randomized, controlled clinical trial of the effectiveness of an asthma self-management program. The relationship between self-reported and electronically recorded daily peak expiratory flow rate (PEFR) adherence was assessed in a sample of 42 children, ages 7 through 11 years with moderate to severe asthma in one community in West Virginia, USA. Cognitive social learning theory served as the framework for the intervention.
Methods: At-home adherence to PEFR monitoring during the 5-week study was evaluated using the self-report Asthma Diary and an electronic PEFR meter. Recommended twice daily (morning and evening) PEFR monitoring was measured.
Results: Self-reported and electronically recorded PEFR adherence were modestly correlated. Self-reported adherence was significantly higher than electronically monitored adherence during Week 5. Accuracy of the self-reported PEFR declined over time, and over half of the children fabricated at least one PEFR value during the final week of the study.
Conclusions: Clinicians often evaluate the efficacy of prescribed treatment for children with chronic conditions based on the children's self-reported diary data. The findings indicate that these children's self-reported adherence behaviors contained errors. Parent education regarding supervision of children's adherence, including validating the accuracy of diary data, is critical for successful self-management in children with chronic conditions.     

The assessment of esophagogastroduodenoscopy tolerance a prospective study of 300 cases

Background: Esophagogastroduodenoscopy (EGD) is useful in the diagnosis and evaluation of dyspepsia. We investigated factors that might be associated with self-reported patient tolerance of EGD and therefore might serve as objective, reliable and useful surrogates for self-reported patient tolerance. We also investigated factors that might influence EGD tolerance.Study: We prospectively evaluated 300 cases prior, during and after an EGD procedure. None received sedation.Results: Seventy-nine percent of patients reported "good" tolerance of their EGD procedure. Other variables including (1) ease of intubation, (2) number and severity of retching episodes and (3) patient's cooperation during the endoscopic procedure, associated positively and robustly with patient self-reports of EGD tolerance. Evaluating the parameters that might predict EGD tolerance, only (4) age and (5) patient's gagging during Lidocaine throat spraying correlated closely with patient perception of EGD intolerance. Self-reported EGD tolerance did not correlate with gender, education level, body habitus (obesity), prior EGD experience, fear or anxiety about the procedure, procedure type or procedure duration.Conclusions: Several parameters might be used instead of or in addition to patient perception of EGD tolerance. Age and patient gagging during Lidocaine throat spraying, but not patient fear and anxiety about the procedure can be used to predict EGD intolerance and used for selection of patients for sedation.     

我国临终关怀准入标准界定的质性研究

目的了解临终关怀实施者、管理者及研究者对临终关怀准入的看法,界定我国临终关怀准入标准。方法采用焦点小组访谈法进行访谈,采用主题分析法整理分析资料。结果提炼出的主题有以预后为基础的准入为主,结合考虑以需求为基础的准入;增加限定条件“对临床根治治疗不获益”;可以考虑缩短准入患者预计生存期的时间;临终关怀准入应先从肿瘤患者入手;可将准入标准的评价指标细化;专业临终关怀机构可作为其他服务的中转站。结论应参考以预后为基础的准入,制定我国临终关怀准入标准。今后随着临终关怀机构的发展扩大,此标准可进一步修订。     

我国临终关怀准入标准界定的质性研究

目的 了解临终关怀实施者、管理者及研究者对临终关怀准入的看法,界定我国临终关怀准入标准.方法 采用焦点小组访谈法进行访谈,采用主题分析法整理分析资料.结果 提炼出的主题有以预后为基础的准入为主,结合考虑以需求为基础的准入;增加限定条件"对临床根治治疗不获益";可以考虑缩短准入患者预计生存期的时间;临终关怀准入应先从肿瘤患者入手;可将准入标准的评价指标细化;专业临终关怀机构可作为其他服务的中转站.结论 应参考以预后为基础的准入,制定我国临终关怀准入标准.今后随着临终关怀机构的发展扩大,此标准可进一步修订.     

我国临终关怀准入标准界定的质性研究

目的 了解临终关怀实施者、管理者及研究者对临终关怀准入的看法,界定我国临终关怀准入标准.方法 采用焦点小组访谈法进行访谈,采用主题分析法整理分析资料.结果 提炼出的主题有以预后为基础的准入为主,结合考虑以需求为基础的准入;增加限定条件"对临床根治治疗不获益";可以考虑缩短准入患者预计生存期的时间;临终关怀准入应先从肿瘤患者入手;可将准入标准的评价指标细化;专业临终关怀机构可作为其他服务的中转站.结论 应参考以预后为基础的准入,制定我国临终关怀准入标准.今后随着临终关怀机构的发展扩大,此标准可进一步修订.     

Item analysis of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST)

The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) is an outcomes assessment tool designed to measure satisfaction with assistive technology in a structured and standardized way. The purpose of this article is to present the results of an analysis of the 24 items comprising QUEST and to explain how a subset of items demonstrating optimal measurement performance was selected. The criteria against which the items were measured were general acceptability, content validity, contribution to internal consistency, test-retest stability, and sensitivity. The items that ranked best in terms of these measurement properties were submitted to factorial analysis in order to complete the item selection. The first series of analyses reduced the item pool approximately by half, and the second series of analyses led to the final selection of 12 items. Factor analysis results suggested a bidimensional structure of satisfaction with assistive technology related to the assistive technology device (eight items) and services (four items). The 12-item revised version that will result from this study should prove to be a reliable and valid instrument for measuring outcomes in the field of assistive technology.