Divorce transition differences of midlife women

Divorce transition experienced by and its influence upon midlife women's health is not fully understood. Interviews were conducted with 24 divorced women who self-classified into decider status groups: initiator (who first decided to end marriage), non-initiator (recipient of end of marriage decision), and mutual decider (shared decision to end marriage). Interpretive content analysis involving pattern coding was conducted. The divorce transition by initiators (n=8) included self-focused growth, optimism, and social support losses and opportunities, while the divorce transition by non-initiators (n=8) included being left, ruminating, vulnerability, and spiritual comfort. No profile emerged for the mutual-decider group (n=8). This study supports that differences in divorce transition exist for initiators and non-initiators.     

Divorce Transition Differences of Midlife Women

Divorce transition experienced by and its influence upon midlife women's health is not fully understood. Interviews were conducted with 24 divorced women who self-classified into decider status groups: initiator (who first decided to end marriage), non-initiator (recipient of end of marriage decision), and mutual decider (shared decision to end marriage). Interpretive content analysis involving pattern coding was conducted. The divorce transition by initiators (n = 8) included self-focused growth, optimism, and social support losses and opportunities, while the divorce transition by non-initiators (n = 8) included being left, ruminating, vulnerability, and spiritual comfort. No profile emerged for the mutual-decider group (n = 8). This study supports that differences in divorce transition exist for initiators and non-initiators.     

A CHILD'S DEATH AND DIVORCE: DISPELLING THE MYTH

In view of the commonly held assumption about a high divorce rate among bereaved parents, a thorough review of literature was conducted to determine what evidence exists. Evidence was found to indicate that a child's death can strain marital relationships, which may lead to separation and/or divorce in some cases; however, there is no conclusive evidence that bereaved parents are likely to divorce as a result of a child's death. On the contrary, it appears that the majority of marital relationships survive the strain brought about by a child's death and may even be strengthened in the long run. The time it takes for bereaved parents to restore their relationship to the level it was before the child's illness and /or death varies depending on the couple and the circumstances involved. The ultimate effects of a child's death on marriage may not be known until after several years have passed. The quality of marital relationship prior to the child's death, cause of death, and circumstances surrounding the death may produce differential outcomes for the marital relationship. In the process of conducting a literature review, a number of questionable or erroneous citations that professionals made were discovered. In addition to those mistakes, confusion between marital distress and divorce appears to be partially responsible for perpetuating the myth of a high divorce rate among bereaved parents. It is time for professionals to dispel the myth. Recommendations for future research are provided.     

A family systems model for divorce and the loss of self

The dissolution of a marriage through divorce represents a major loss in the lives of all family members. Losses can include those of a physical, social, and emotional nature. The self as it was defined within the marital context and the loss of that self as a result of divorce is a significant source of potential dysfunction in adult family members during and after the divorce. From a family systems' perspective, the lower the level fo differentiation of self in family members, the greater is the likelihood that the self was defined in a fusional way during the marriage. As such, when the fused common self is lost through divorce, one or both spouses is likely to experience a significant sense of loss as well as potential dysfunction. The purpose of this article is to propose a model that helps divorced people deal with the loss of self and assists them to define a more differentiated sense of self.     

Social Networks and Social Support of Recently Divorced Women

Abstract A study of the support networks and social support of recently divorced women with children was conducted over two years. Its purpose was to assess changes in the women's social support and identify their unmet needs. Data were collected from 148 women by mailed questionnaire and telephone interview soon after the final divorce decree, and again at two years. The women did experience a significant decrease in network size and social support over two years; however, the primary members of their networks—family and friends—remained stable. Women with preschool-age children had more family support than those with older children. Nine categories of unmet needs were identified. Most frequently cited, in descending order, were emotional support, financial assistance, need for a boyfriend/partner/spouse, time for herself, and child care. The average number of needs per woman was less than two. The findings of this study confirm the losses in overall network size and support that women experience after divorce. The identification of unmet needs helps nurses to target areas in which women may require assistance to find social support.     

Older married couples and health promotion: joint decision-making process for long-term spouses

The purpose of this study was to explore communication patterns between long-term married couples to better understand the process by which later-life couples participate in health promotion. Forty community-residing couples married for 30 years or longer were asked to respond to open-ended questions and to participate in a decision-making activity. The majority of couples made health decisions jointly, with wives acting as the final deciders 54% of the time. Most couples used positive communication strategies during a structured scenario. Findings highlight the importance of expanding beyond traditional individual-focused models to include joint decision-making processes. Implications for future research and for nursing practice are discussed.     

Impact of hormone therapy on false-positive recall and costs among women undergoing screening mammography

OBJECTIVE: We sought to evaluate the effects of hormone therapy (HT) on false-positive (FP) recall for additional breast evaluation and costs. DESIGN: We undertook an observational cohort study of women ages 40-80 years with 2 mammography screenings in an integrated delivery system. MEASURES: FP recall, defined as mammograms resulting in a radiologist's recommendation for additional imaging, ultrasound, or invasive procedures among disease-free women, was compared for nonusers, initiators, discontinuers, and continuers of HT. Differences in health care costs by HT were assessed for total, primary care, specialty, laboratory, radiology, inpatient, mental health, and pharmacy. RESULTS: There was no association between HT and FP recall among women ages 40-49 years. Among women 50 years or older, current HT users, ie, initiators and continuers, had increased odds of FP recall (odds ratio; 95% confidence interval) compared with nonusers (1.2; 1.0-1.4 for women 50-59 years; 1.8; 1.5-2.2 for women 60-69; and 1.7; 1.4-2.0 for women 70-80 years). Among women 50-59 years, the odds of FP recall were attributed to opposed HT (ie, estrogen+progestin). Increases in FP recall among HT users 60 years and older was maintained for initiators, continuers, opposed, and unopposed (estrogen only). Increases in FP recall among HT users were for imaging and ultrasound but not invasive procedures. Costs for current HT users during the 12 months after screening were not higher than nonusers, except for pharmacy and outpatient mental health. CONCLUSION: The relationship between HT use and FP recall is greatest among older women and does not result in a differential use of invasive procedures.     

Understanding African-American participation in a behavioral intervention: results from focus groups

Heart failure (HF) is an increasingly prevalent condition contributing to significant morbidity and mortality among African-Americans. The Heart Failure Adherence and Retention Trial (HART) is the largest NHLBI funded behavioral clinical trial of patients with HF (R01 HL65547). The HART trial has recruited approximately 40% minority participants, with 33% being African-American. The purpose of this qualitative study is to conduct an in-depth examination of the subjective experience of African-American participants in the intervention arm of the HART. Five focus groups were conducted with a total of 25 participants. The mean age of those attending was 55 years, with a range between 39 and 82 years, 52% of the participants were female, and 92% were African-American. Participants gained overall general medical knowledge about HF and how HF influenced their own lives. Participants appeared not only to understand the self-management skills that were taught; but also how to apply them. They also demonstrated understanding of the connection between lifestyle and HF. Factors that may promote retention include mutual support, the opportunity to engage in meaningful social activity, and feeling cared for. Factors that may limit retention include anxiety and denial about HF and logistical and emotional barriers to attending groups. Factors with unclear effects on retention include remuneration, ethnicity of the group leader, and the role of religious or spiritual content in meetings. While a number of perceived benefits exist to group participation, there are significant and logistical barriers to retention. Ongoing attention to cultural sensitivity is a likely factor in successful retention of study participants.     

Cognition and adjustment among children of separated or divorced parents

The current study tested the hypothesis that coping with stress is associated with the individual's cognitive appraisals of the stressor and of their resources for coping with the stressor. Fifty-two children between 8.5 and 12 years of age who were experiencing the separation or divorce of their parents were given a measure of appraisals of divorce and a measure of appraisals of coping options. Their parents and teachers filled out behavior checklists, and teachers reported their classroom grades. For boys, appraisals of divorce situations were related to behavior in the home but not in the school. Boys' adaptive appraisals tended to be more strongly associated with behavior than were maladaptive appraisals. Their appraisals of coping options were related to personal adjustment in both the home and the school, but not to academic performance. For girls, only a few of the relationships between cognition and psychosocial adjustment were significant, possibly because of their restricted range of grades and scores on the behavior checklists. These findings provide partial support for the prediction that coping is related to appraisals of stressful events and of one's resources for coping with the events.     

National variability in permanent partial impairment ratings

OBJECTIVE: To evaluate the variability in permanent partial impairment ratings of three different clinical vignettes by physiatrists throughout the United States with regard to location in the country, years of experience, and type of practice. DESIGN: Participants were asked to fill out a questionnaire requesting their state of practice, number of years in practice, scope of their practice, and percentage of their time devoted to worker's compensation cases. They were also given three clinical scenarios and were asked for the diagnosis of each, along with an impairment rating and how that rating was obtained. RESULTS: The range of impairment ratings for the case of radiculopathy was 0-14%. The range for the case of radial neuropathy was 3-60%. The range for the total hip replacement case was 8-100%. The responses did not correlate with region, years of experience, or type of practice except in the first case, in which a trend was noted that the younger respondents gave lower ratings. Participants used different sources for obtaining their results, which included the third, fourth, or fifth edition of the American Medical Association's guides to impairment. Some used their state guides, whereas others used their clinical judgment. CONCLUSION: There is a great deal of variability of permanent partial impairment ratings throughout the country; several different sources are used to determine ratings.     

Trowels labeled ergonomic versus standard design: preferences and effects on wrist range of motion during a gardening occupation.

OBJECTIVE: The purposes of this study were to determine whether a garden trowel labeled ergonomic provided better wrist positioning when planting than a standard-designed trowel and whether participants perceived the ergonomic labeled trowel as more comfortable and easier to use than the standard-designed trowel. METHOD: Participants included 64 females, ages 20-50 years, with no self-reported disease or disability impairing their preferred upper extremity. Participants used both trowels to fill flowerpots with soil in a randomized, repeated measures, counterbalanced design. The wrist movements of ulnar and radial deviation, and palmar and dorsiflexion were measured with an electrogoniometer (Penny and Giles Biometrics Limited Goniometer XM65). Participants answered questions regarding their interest in gardening, ease of use and comfort of each trowel, and trowel preference. RESULTS: A one-tailed paired ttest showed that the trowels did not differ in the extremes of dorsiflexion elicited and the extremes of the other wrist movements were not in the predicted direction. Participants rated the trowels similarly for comfort and ease of use. Participants were evenly divided on personal preference for the two trowels. CONCLUSION: Occupational therapists should be cautious when recommending a gardening trowel based on it being labeled ergonomic, as it may not produce better wrist positioning than a non-ergonomically labeled trowel. Fitting a person with the right trowel involves an assessment of tool-influenced wrist positioning as well as individual perceptions of comfort and ease of tool use.     

Treatment Patterns in Disease-Modifying Therapy for Patients With Multiple Sclerosis in the United States

Background

Patients with multiple sclerosis (MS) whose disease activity is inadequately controlled with a platform therapy (interferon beta or glatiramer acetate [GA]) may switch to another platform therapy or escalate therapy to natalizumab or fingolimod, which were approved in the US in 2006 and 2010, respectively.

Objective

The objective of this study was to describe treatment patterns in patients with multiple sclerosis (MS) in the United States who were followed for 2 years after initiating a disease-modifying therapy (DMT).

Methods

A retrospective observational cohort study was conducted to examine treatment patterns of initial DMT use (on initial therapy for 2 years with and without gaps of ≥60 days, medication switching, and discontinuation) among patients with MS who initiated a platform therapy (interferon-β or glatiramer acetate) or natalizumab between January 1, 2007, and September 30, 2009; the first DMT claim was the index. Eligible patients were identified in the MarketScan Commercial and Medicare Supplemental databases based on continuous enrollment for 6 months before (preindex period) and 24 months after their index date, with a diagnosis of MS and no claim for a previous DMT in the 6-month preindex period. Demographics at index and clinical characteristics during the preindex period were also analyzed.

Results

A total of 6181 MS patients were included, with 5735 (92.8%) starting on platform therapy. Natalizumab initiators were more likely to stay on index therapy (32.3% vs 16.9%, P < 0.001) and have fewer treatment gaps of ≥60 days (44.8% vs 55.3%, P < 0.001) compared with platform initiators. In addition, natalizumab initiators were less likely to switch treatment (13.9% vs 19.1%, P = 0.007) and took longer to switch (400.9 days vs 330.7 days, P < 0.001) compared with platform initiators. Nearly 79% of platform initiators who switched went to another platform therapy. Approximately two thirds of patients who switched to a third DMT (n = 130) switched to another platform therapy. A total of 9% of natalizumab and platform initiators discontinued DMT within the 2 years.

Conclusions

Most MS patients initiating DMT started on platform therapy. Natalizumab initiators tended to stay on index therapy, have fewer treatment gaps, and switch less than platform initiators in the 2 years after treatment initiation. Switching between platform therapies is common despite evidence that MS patients on platform therapy may benefit from switching to natalizumab.     

Mothers' experiences of serious life events increase the risk of diabetes-related autoimmunity in their children

OBJECTIVE: Stressful life events have been shown to constitute a risk factor for type 1 diabetes during childhood. Our aim was to investigate in the general child population (i.e., irrespective of genetic risk for type 1 diabetes) whether mothers' experiences of serious life events, such as divorce and violence, were associated with diabetes-related autoimmunity in their children at age 2.5 years. RESEARCH DESIGN AND METHODS: The study cohort was comprised of the first 5,986 consecutive children and their families from the prospective population-based All Babies in Southeast Sweden project for whom 2.5-year study data were available. Data were drawn from parental questionnaires that included questions about experiences of serious life events and the blood samples taken from the children when the children were age 2.5 years. The blood samples were analyzed for diabetes-related autoantibodies against tyrosine phosphatase and GAD. RESULTS: Mothers' experiences of divorce (odds ratio 3.6, 95% CI 1.4-9.6, P < 0.05) and violence (2.9, 1.0-7.8, P < 0.05) were associated with diabetes-related autoimmunity in the children, independent of a family history of type 1 diabetes. CONCLUSIONS: The results support the beta-cell stress hypothesis and suggest that maternal experiences of serious life events such as divorce and violence seem to be involved in the induction or progression of diabetes-related autoimmunity in children at age 2.5 years, independent of family history of type 1 diabetes.     

Symptom experience in Korean patients with liver cirrhosis

This study was done to examine the level of symptom experience, and symptom variation in relation to demographic and clinical variables, in Korean patients with liver cirrhosis (LC). Symptom experience was measured using a scale developed by the researchers through a literature review on LC. Participants were 129 patients whose mean age was 53.6 (standard deviation [SD] = 9.28) years. The results indicated that (1) overall symptom experience was relatively low (mean 41.67, SD 24.71); (2) the main symptoms needing a management were fatigue, abdominal distension and/or peripheral edema, and muscle cramps; and (3) among the study variables, the severity of LC (P < 0.001) and the number of hospitalizations (P = 0.014) showed a significant relationship with overall symptom experience. These results suggest that symptom assessment requires a multidimensional approach and that it is imperative to consider disease severity in developing tailored symptom management programs for Korean patients with LC.     

Is the Verbal Numerical Rating Scale a Valid Tool for Assessing Pain Intensity in Children Below 8 Years of Age?

The verbal numerical rating scale (vNRS-11) is one of the most widely used scales for assessing pediatric pain intensity. The literature shows that it is a valid instrument for assessing pain intensity in children above 8 years of age. The aim of this work was to study whether the vNRS-11 is also a valid instrument when it is used with Catalan-speaking children between 6 and 8 years old. A total of 126 schoolchildren (mean age, 6.87; SD, .68) were interviewed individually. Participants reported the maximum intensity of the most frequent pain they had experienced in the previous 3 months, and the intensity they would experience in 3 circumstances, using the vNRS-11 and other widely used scales: the Faces Pain Scale-Revised (FPS-R), the mechanical visual analog scale (VAS), and the colored analog scale (CAS). They rated their affective state in relation to the pain experience and reported their pain-related disability. Participants also indicated which of the 4 scales they preferred. The vNRS-11 showed a high convergent construct validity (r = .73–.86), adequate discriminant validity (z = 2.05–5.55), and adequate criterion-related validity (r = .45–.70). The vNRS-11 was the second most preferred scale.PerspectiveThis study contributes to the increasing literature that supports the use of the vNRS-11 to assess pain intensity in children. Specifically, it shows that it can be used in children as young as 6 years of age.     

Burn-injured adolescents report gaining multiple developmental benefits and improved life skills as a result of burn camp attendance

Anecdotally, burn camp has been reported to be a positive developmental and rehabilitative experience for attendees; there is little empirical data to support this belief. This study sought to explore whether burn camp either directly or indirectly elicits positive development outcomes in pediatric burn survivors or increases their psychosocial well-being and achievement. The Youth Experience Survey 2.0, a 66-item self-report inventory designed to measure developmental experiences in an organized youth activity, was administered to children aged 11 to 18 years attending summer burn camp. One hundred and ten burn-injured youth, 58 male and 52 female, reported that burn camp had positively impacted their lives through improved identity exploration, goal-setting and problem-solving abilities, increased physical activity, communication, emotional regulation, and time management skills (P < .0001). Participants reported more positive experiences than the norm group and higher mean scores on 90% (48) of the 53 positive items. Attendance at burn camp for more than 5 years resulted in greater improvement. Study results support the burn camp experience as a far-reaching and positive developmental activity. Participants credited the camp experience with helping them with identity formation and reflection, improved social interactions, and increased initiative; all positive developmental outcomes for youth. Results suggest that burn camp participation not only helps burn-injured youth to deal with their burns but also assists them in the development of social and basic life skills, which will allow them to navigate the transition from youth to adulthood, more effectively and successfully.     

Doing the best I can do: moral distress in adolescent mental health nursing

The purpose of this research was to explore the process used by mental health nurses working with adolescents to ameliorate the experience of moral distress. Using grounded theory methodology, a substantive theory was developed to explain the process. All the incidents that led to the experience of moral distress were related to safety and resulted in the nurses asking themselves the question, "Is this the best I can do?" Engaging in dialogue was the primary means nurses used to work through the experience of moral distress. Engaging in dialogue was an ongoing process, and nurses sought out dialogue with a variety of people as they tried to make sense of their experience. Participants identified qualities of dialogue that were helpful or unhelpful as they sought to resolve their moral distress. Participants who had a positive experience of dialogue were able to answer the "Is this the best I can do" question satisfactorily and continue working with adolescents with a renewed focus on the therapeutic relationship. Participants who had a negative experience of dialogue are unable to answer the question and either left the unit or agency or talked about leaving.