Relationship of resources to emotional distress, somatic complaints, and high-risk behaviors in drug recovery and homeless minority women

In a sample of 581 homeless or drug-abusing minority women, the relationship of self-esteem, sense of coherence, and support availability to emotional distress, somatic complaints, and high-risk behavior were investigated. Findings revealed that women who were high in self-esteem and stronger in sense of coherence reported significantly less emotional distress, and significantly fewer high-risk behaviors. In addition, women who were high in any of the three resources reported lower somatic complaints. Regression analyses revealed that coherence, self-esteem and support availability jointly accounted for 49% of the variance in emotional distress, 10% of the variance in high-risk activities, and 26% of the variance in somatic complaints. Implications for empowering women at risk for HIV infection are discussed.     

Adaptation of wives to prostate cancer following diagnosis and 3 months after treatment: a test of family adaptation theory

BACKGROUND: Prostate cancer challenges not only the men with the disease, but also their partners. Existing studies have focused on the relationship between type of treatment and sexual and urinary function in men, with recent qualitative work suggesting that men and their spouses have differing responses to the illness. Factors predicting women's adaptation to prostate cancer have not been examined. OBJECTIVES: Using a model derived from family stress and adaptation theory, this study examined (1) the contribution of urinary and sexual symptoms, sense of coherence, marital resources and situational appraisal to wives' global adaptation (PAIS) and emotional adaptation (POMS), and (2) the role of situational appraisal as a mediator between the set of independent variables and PAIS and POMS. DESIGN: In a prospective, correlational design, data were collected from 70 women following their partners' diagnosis and again 3 months later. METHODS AND RESULTS: Using a path analysis approach, between 30% and 62.7% of the variance in global adjustment and mood disturbance was explained across model tests. Sense of coherence was a strong and consistent predictor. Appraisal acted as a mediator only at time 2, mediating the effect of symptom distress on global adaptation. Change in sense of coherence and change in family resources predicted global adaptation and emotional adaptation at time 2, and predicted the change between time 1 and 2 in those variables. CONCLUSIONS: The findings suggest nursing interventions that mobilize and build wives' sense of the manageability, meaningfulness and comprehensibility of life events, and that foster cohesion and flexibility within the marital relationship. Interventions that mitigate the impact of urinary symptoms and the appraisal of threat in the illness event are also indicated. Additional model-testing studies based on family adaptation theory with patients and family members in other types of cancer would help build nursing knowledge for interventions in cancer.     

Does gender affect appraisal of pain and pain coping strategies?

OBJECTIVE: To investigate the impact of gender and a set of pain characteristics on the threat or challenge appraisal of pain and the impact of these appraisals on the coping strategies used to manage the pain. DESIGN: This study used a community telephone survey to examine these relationships for a troublesome pain experienced by respondents in the 2 weeks preceding the interview. STUDY RESPONDENTS: The sampling frame consisted of 1,430 households randomly selected from the Halifax-Dartmouth-Bedford community. Of the 390 respondents with a troublesome pain in the 2 weeks preceding the interview, 309 respondents agreed to participate (79% response rate). RESULTS: Women tended to report more pain located in the head and more somatic problems. They reported significantly more intense pain. For women and men, the most important impact on threat appraisal of pain was overall interference of pain and emotional upset due to pain. These two variables accounted for 48% of the variance in threat appraisal for women and 37% of the variance for men. There was no gender difference in emotional upset due to pain or in the impact of emotional upset on threat appraisal. There was no gender difference in challenge appraisal. Threat appraisal was associated with increased catastrophizing whereas challenge appraisal was associated with positive self-statements. Women reported significantly more problem solving, social support, positive self-statements, and palliative behaviors than did men. CONCLUSIONS: Interference of pain has a greater impact on threat appraisal of pain for women. Increasing threat appraisal is associated with health care utilization for women, but women's more frequent use of several coping strategies is unrelated to their appraisal of pain. Appraisal of pain may have important implications on coping and overall well-being of women and men.     

Self-esteem and optimism in men and women infected with HIV

BACKGROUND: Self-esteem and optimism have been associated with appraisal and outcomes in a variety of situations. The degree to which the contribution of self-esteem and optimism to outcomes over time is accounted for by the differences in threat (primary) or resource (secondary) appraisal has not been established in persons with human immunodeficiency virus (HIV). OBJECTIVES: To examine the longitudinal relationship of personality (self-esteem and optimism) on primary and secondary appraisal and outcomes of well-being, mood, CD4+ T-lymphocyte count, and selected activities. METHODS: Men (n = 56) and women (n = 42) infected with HIV completed eight self-report measures twice over 18 months. Hierarchical Multiple Regressions were used to examine the relationship of personality variables on appraisals and outcomes. The mediating effects of primary and secondary appraisals were explored. RESULTS: Self-esteem uniquely accounted for 6% of the variance in primary appraisal and 5% in secondary appraisal. Optimism accounted for 8% of the unique variance in secondary appraisal. Primary and secondary appraisal mediated differently between personality and outcome variables. A strong predictor of well-being, mood disturbance, and activity disruption at Time 2 was participants' initial level of these variables. Socioeconomic status was a strong predictor of mood. CONCLUSIONS: Self-esteem and optimism are important but different resources for adapting to HIV disease. Strategies for reducing threats and increasing resources associated with HIV may improve an individual's mood and sense of well-being.     

Knowledge, self-efficacy, coping, and condom use among urban women.

In this study, path analysis was used to test a model of the relationships among condom use knowledge, self-efficacy for condom use, coping, and condom use in a sample of 100 urban women. In the final model, the paths between condom use knowledge and self-efficacy, between self-efficacy and condom use, and between self-efficacy and problem-focused coping were significant. In addition, condom use knowledge was indirectly related to condom use through self-efficacy. The final model accounted for 43% of the variance in condom use. Although the women engaged in risky behaviors including having multiple partners, high-risk sexual partners, and unprotected intercourse, they did not worry about or perceive themselves at risk for HIV. To assist women to decrease their risk for sexually transmitted HIV infection, clinicians should conduct individualized assessments of each client's sexual behaviors to identify women at risk. Individualized interventions are recommended to increase both knowledge of how to use condoms and self-efficacy for condom use among women at risk for HIV.     

Personality,appraisal, and adaptational outcomes in HIV seropositive men and women

A cross-sectional exploratory design was used to assess the relationships of personality, socioeconomic status, and appraisal with functional and emotional outcomes in 77 men and 50 women with HIV infection. Multiple regression analysis showed that, among men, socioeconomic status moderated the negative relationship between self-esteem and disruption in usual activities. Consistent with Lazarus and Folkman's (1984) theory, appraisal of HIV threat mediated the negative relationship between self-esteem and mood disturbance for men and women, and the positive relationship between self-esteem and purpose in life for women. Appraisal did not mediate between personality variables and disruption in usual activities or life satisfaction for men or women. ©1995 John Wiley & Sons, Inc.     

The quality of life of African American women with breast cancer

The objectives of this study were to describe the quality of life of African American women with breast cancer and test a model of factors that may affect their quality of life. A stress-coping framework that included person (demographics, current concerns, and optimism), social resources (family functioning), and illness-related factors (symptom distress, medical characteristics), as well as appraisal of illness and quality of life, was used to guide this exploratory, cross-sectional study. Participants included 98 African American women who were approximately 4 years postdiagnosis. The women reported a fairly high quality of life, were generally optimistic, and had effective family functioning. Although symptom distress was generally low, a sizable number of women reported problems with energy loss, sleep disturbances, and pain. The model explained 75% of the variance in quality of life, with appraisal, family functioning, symptom distress, and recurrence status each explaining a significant amount of the variance. Current concerns had an indirect effect on quality of life that was mediated by appraisal. These findings underscore the importance of helping women foster a positive appraisal of their illness, manage current concerns, maintain family functioning, and reduce symptom distress, because each of these factors indirectly or directly affects their quality of life.     

Uncertainty, coping, and distress following myocardial infarction: transition from hospital to home

The purpose of this study was to examine the influence of uncertainty in illness and use of coping methods on emotional distress and recovery following myocardial infarction. A longitudinal exploratory design with measures obtained at three times was used; multiple regression was used to analyze the data. Uncertainty explained a significant amount of the variance in emotional distress prior to hospital discharge (21%), and 1 (16%) and 4 (26%) weeks after discharge. Patients reporting greater uncertainty also reported more emotional distress. One week after discharge, coping behaviors significantly added to the variance explained in distress (27%). Greater use of emotive coping behaviors was associated with higher levels of emotional distress and accounted for the majority of the variance explained by coping behaviors (23%). The findings are discussed in terms of the nature of uncertainty in health care and future model development.     

Perception of HIV and safer sexual behaviors among lesbians.

There is little data on female-to-female transmission of HIV. Some women who have sex with women (WSW) have other high-risk behaviors that could lead to HIV infection. The belief that WSW are at no risk may lead to unsafe sexual practices. In this study, a convenience sample of 78 women was surveyed in order to explore the perception of HIV risk among lesbians, their sexual behaviors, and their sources of information about safer sex. Fifty-three percent reported they were at low risk for contracting HIV. Women reported knowledge of barrier methods (89% to 99%) and no sex during menstruation (92%). However, 35% to 40% reported no knowledge of less common safer sex practices. Women reported their source of knowledge as media (36%), workshops (22%), and friends (12%). Eighty-five percent stated that their health care provider knew they were lesbian, but only 15% reported receiving safer sex education. Nurses and nurse practitioners are aptly poised to provide critical HIV education and health care for this population.     

Cognitive and affective features of postpolio syndrome: Illness uncertainty,attributional style,and adaptation

We examined a sample of 58 individuals with postpolio syndrome (PPS). Subjects completed measures of illness severity, perceived support from the medical community, attributional style, illness uncertainty, and general emotional adaptation. We found elevated levels of emotional distress across several parameters of emotional adaptation. Illness uncertainty and generalized negative outcome expectancies were strongly associated with poorer adaptation; disease severity and perceived support from the medical community did not relate to measures of emotional adaptation. Hierarchical multiple regression analyses revealed that illness uncertainty and both stable and global attributions for negative events contributed significant, unique variance to the prediction of psychological distress beyond the influence of illness severity and demographic parameters. In general, individuals with PPS appear to be at risk for problems in adaptation, and specific cognitive appraisal processes appear to play an influential role in the development of these problems. Our findings have general implications for clinical management of persons with PPS.     

Threat appraisal, coping, and emotions across pregnancy subsequent to perinatal loss

BACKGROUND: Pregnancies after perinatal loss are known to be anxiety-filled. Stress in pregnancy and the response to it, often seen as anxiety and depression, have known negative consequences for obstetric outcomes, parenting, and infant behaviors. Women have reported fluctuating emotions in response to events in their subsequent pregnancies, but these pregnancies have not been studied longitudinally. OBJECTIVES: To test Lazarus' theory of stress, coping, and emotions in this population, and to understand the patterns of threat appraisal, coping, and emotional states of women across pregnancy after perinatal loss. METHODS: In this predictive correlational study, 82 women pregnant after loss (PAL) were followed, and the study was guided longitudinally by Lazarus' theory of stress, coping, and emotions. Obstetric and loss history, and assigned fetal personhood were gathered at intake (Time 1). Measures completed at 10-week intervals (one time each trimester) included Moneyham Threat Index (threat appraisal), Ways of Coping Checklist-Revised (relative coping), Pregnancy Anxiety Scale (pregnancy anxiety), Multiple Affect Adjective Checklist-Revised (emotional states), and Stress in Life (stress). Time 3 sample size was 70. RESULTS: Threat appraisal was correlated with assigned fetal personhood and gestational age of past loss. Pregnancy subsequent to loss was perceived as a threat, and threat appraisal strongly predicted pregnancy anxiety. Pregnancy anxiety, reported at moderate levels on average, decreased over time; threat appraisal, coping, and other emotions were stable across pregnancy. Coping did not mediate these effects, but relative coping was correlated with emotional status as theorized, with problem-focused coping used more than emotion-focused coping. DISCUSSION: Women find pregnancy after loss stressful and a threat, and this appraisal remains across pregnancy. Because pregnancy anxiety is common, and highest in early pregnancy, providers should address worries and fears with all women early in PAL. Interventions must be tested in future studies.     

2012年山西省太原市男男性行为人群艾滋病哨点监测分析

目的 了解太原市男男同性性行为人群(men who have sex with men,MSM)中艾滋病高危行为特征、艾滋病防治知识知晓率及艾滋病/性病感染状况。方法 按照《全国艾滋病哨点监测实施方案操作手册》(2012年版),对MSM人群进行问卷调查,并采集静脉血样进行人类免疫缺陷病毒(human immunodeficiency virus, HIV,艾滋病病毒)、梅毒和丙型病毒性肝炎的血清学检测。结果 2012年太原市共监测254例MSM,HIV抗体阳性率为13.78%;梅毒阳性率10.23%;丙型病毒性肝炎阳性率0.79%。监测对象艾滋病知识知晓率为90.55%。被调查者调查前6个月有78.74%的人与男性发生过肛交性行为,每次使用安全套占44.50%,其中4.50%与同性发生过商业性行为;30.31%的MSM与女性发生过性行为, 每次都使用安全套占41.56%。结论 太原市MSM人群艾滋病/性病感染率较高,高危行为较普通,应继续加强对该人群的行为干预,遏制艾滋病在MSM人群中的传播。     

Developing culture-specific interventions for Latinas to reduce HIV high-risk behaviors.

Latina women are among the fastest-growing segments of the U.S. population to become infected with HIV. Health care providers must use culture-specific HIV prevention strategies and must address cultural roles and values of the Latin community to empower Latinas to reduce high-risk behaviors. Some Latinas adhere to their cultural traditions that place the female subservient to the male in the sexual relationship. A review of the literature reveals that skills-building, a group participatory tool that engages the individual to examine high-risk behaviors and provides methods to make behavior changes, and nurse counseling, which focuses on an individual's specific risk behaviors, are more effective modes of reducing high-risk behaviors in women than an information-only intervention.     

Outcomes of specialized and traditional AIDS counseling programs for impoverished women of color

The efficacy and differential effects of specialized (S) and traditional (T) AIDS education programs on cognitive, behavioral, and psychological outcomes were investigated. The sample consisted of 858 impoverished African-American and Latina women (S = 448, T = 410). At baseline, women in the traditional group reported significantly higher distress, greater knowledge of AIDS, and less problem-focused coping. Significant improvements over the 2-week intervention interval were found for participants of both AIDS education programs for appraisal of threat, concerns, knowledge, and attitudes about AIDS, emotion-focused coping, number of sexual partners, IV and non-IV drug use, depression, and distress. However, multivariate analysis indicated that the traditional group had slightly better posttest scores on concerns, emotionfocused coping, knowledge of AIDS, and number of partners than the specialized group. The specialized group reported greater use of problem-focused coping. These differences do not detract from the substantial improvement found for both groups, but they do reinforce the conclusion that the specialized program was not more effective than its standard counterpart. © 1993 John Wiley & Sons, Inc.     

An HIV self-care symptom management intervention for African American mothers

BACKGROUND: Human immunodeficiency virus (HIV) infection has become a serious health problem for low-income African American women in their childbearing years. Interventions that help them cope with feelings about having HIV and increase their understanding of HIV as a chronic disease in which self-care practices, regular health visits, and medications can improve the quality of life can lead to better health outcomes. OBJECTIVE: This study aimed to determine the efficacy of an HIV self-care symptom management intervention for emotional distress and perceptions of health among low-income African American mothers with HIV. METHOD: Women caregivers of young children were randomly assigned to self-care symptom management intervention or usual care. The intervention, based on a conceptual model related to HIV in African American women, involved six home visits by registered nurses. A baseline pretest and two posttests were conducted with the mothers in both groups. Emotional distress was assessed as depressive symptoms, affective state, stigma, and worry about HIV. Health, self-reported by the mothers, included the number of infections and aspects of health-related quality of life (i.e., perception of health, physical function, energy, health distress, and role function). RESULTS: Regarding emotional distress, the mothers in the experimental group reported fewer feelings of stigma than the mothers in the control group. Outcome assessments of health indicated that the mothers in the experimental group reported higher physical function scores than the control mothers. Within group analysis over time showed a reduction in negative affective state (depression/dejection and tension/anxiety) and stigma as well as infections in the intervention group mothers, whereas a decline in physical and role function was found in the control group. CONCLUSIONS: The HIV symptom management intervention has potential as a case management or clinical intervention model for use by public health nurses visiting the home or by advanced practice nurses who see HIV-infected women in primary care or specialty clinics.