Nursing care resources for individuals with intellectual and developmental disabilities across the life span

This article provides resources that can be used by nurses working with individuals with intellectual and developmental disabilities (I/DD) across the life span and in a variety of settings. Resources include books, articles, videos, disability-related organizations, professional organizations, and agencies providing disability-related services. Additionally, resources are provided on a range of topics, including advocacy, issues across the lifespan for individuals with I/DD, health promotion, and legislation.     

Cardiovascular risk factor modification: is it effective in older adults?

Older adults over the age of 65 are the fastest growing segment of the US population. However, the prevalence of cardiovascular disease (CVD) is highest in this population and CVD is the primary cause of death for elders. Cardiovascular disease risk factors are similar for both younger and older age groups and include hypertension, cigarette smoking, hyperlipidemia, and diabetes. Evidence for managing and treating these CVD risk factors in elders is presented.     

Bone scintigraphic findings in patients with foot ulcers and normal plain film radiographs

A prospective study was performed to examine the performance of bone scintigraphy in the earliest stage of soft-tissue foot ulceration with potential risk for progression to osteomyelitis. Twenty-three podiatry clinic patients with new or recurrent foot ulcers but negative plain film radiographs of the foot underwent 24 (one patient was studied twice) multiphase bone scans (flow, blood pool, and 3- and 24-hour delayed images) that were visually scored for severity of increased uptake on a scale of 0 to 3+, with 0 indicating normal and 3+ indicating severe. Twenty-one scans (88%) showed abnormal uptake on at least one phase, with 17 (71%) having increased bone uptake on late images. Ulcer healing without complications occurred in 20 cases (83%), whereas 4 cases had adverse outcomes, 3 requiring surgical resection for failure to heal and 1 having radiographic progression to frank osteomyelitis. All three patients whose bone scans showed severe abnormal uptake had an adverse clinical outcome.     

Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women

BACKGROUND: National surveys of food intake rely on the 24-h dietary recall method for assessing the nutrient intakes of Americans. OBJECTIVES: This observational validation study was conducted under controlled conditions to test the effectiveness of the US Department of Agriculture (USDA) 5-step multiple-pass method for dietary recall; to test the ability of normal weight, overweight, and obese women to recall food intake; and to test the accuracy of macronutrient recall. DESIGN: Women (n = 49) aged 21-65 y with a body mass index (in kg/m(2)) of 20-45 selected all meals and snacks for 1 d from a wide variety of foods. A 24-h dietary recall with the use of the USDA 5-step multiple-pass method was administered by telephone the following day. Analysis of variance and covariance tested the overall accuracy of recall and the effect of BMI on dietary recall. RESULTS: As a population, the women overestimated their energy and carbohydrate intakes by 8-10%. No significant differences between mean actual and recalled intakes of energy and the macronutrients were observed in the obese women. Normal-weight and overweight women significantly (P < 0.01) overestimated their energy, protein, and carbohydrate intakes. Recalled fat intake was not significantly different from actual intake in women across the BMI range studied. CONCLUSIONS: The USDA 5-step multiple-pass method effectively assessed mean energy intake within 10% of mean actual intake on the previous day. Obese women more accurately recalled food intake than did overweight and normal-weight women despite undereating on the day of the study.     

Factors influencing physical activity levels among Canadian youth

OBJECTIVES: To describe the predisposing, enabling and reinforcing factors influencing the levels of physical activity among Canadian youth (ages 12-24). METHODS: Analyses of the 1996-97 National Population Health Survey (NPHS) were conducted using data collected from female (n=6195) and male (n=5925) Canadians aged 12-24 years. The data were analyzed using correlational, ANOVA and regression procedures with post hoc analyses (Bonferroni) employed where applicable. RESULTS: Compared to males, Canadian female youth were found to be less physically active, more concerned about being overweight, more depressed, and to consult mental health professionals more frequently. On the other hand, females were more likely to report greater social support than males and to be more socially involved. Those adolescents who smoke tend to be less physically active and, along with those who consume alcohol, have poorer health. DISCUSSION: The significant predisposing, enabling and reinforcing factors influencing youths' physical activity levels more profoundly affect females. The results are discussed in terms of strategies for enabling physical activity available in the literature. In addition to individual determinants influencing physical activity, a move toward understanding policy and environmental factors is recommended for further research.     

Socioeconomic status,sense of coherence and health in Canadian women

OBJECTIVE: The purpose of this study was to explore the role of sense of coherence (SOC) in the relationship between household income and self-rated health among Canadian women. SOC is a global orientation that enables one to perceive events of the world as comprehensible, manageable, and meaningful. METHODS: A secondary data analysis was conducted using the National Population Health Survey 1994-95. Only women between the ages of 20 and 64 (n = 6748) were selected for this study. Data were analysed using multivariate path analyses. RESULTS: SOC is a psychosocial factor that intervenes in the income and health relationship. It did not function, however, as an interaction buffer to ameliorate the adverse effects of low income on health. CONCLUSION: This study lends support for public health interventions that target the socioeconomic conditions that influence health, and for strategies that foster the development of a strong SOC.     

Bakery products enriched with phytosterol esters, alpha-tocopherol and beta-carotene decrease plasma LDL-cholesterol and maintain plasma beta-carotene concentrations in normocholesterolemic men and women

The hypocholesterolemic effects of phytosterols have not been evaluated in bakery products, and the addition of liposoluble antioxidants to the carrier has never been tested. We investigated the effects of consuming croissants and magdalenas (Spanish muffins) enriched with sterol esters, alpha-tocopherol and beta-carotene on plasma lipid and fat-soluble antioxidant concentrations in normocholesterolemic, habitual consumers of bakery products following their usual diet and lifestyle. Using a randomized, double-blind, placebo-controlled design, the control (C) group (n = 29) received two pieces daily (standard croissant and muffin) and the sterol ester (SE) group (n = 28), the same products with sterol esters added (3.2 g/d) for 8 wk. Total and LDL cholesterol (LDL-C) decreased in the SE group by 0.24 mmol/L (P < 0.01) and 0.26 mmol/L (P < 0.005), respectively, whereas these variables did not change in the control group. The total difference in total and LDL-C changes between groups was 0.38 mmol/L (8.9%) and 0.36 mmol/L (14.7%), respectively (P < 0.001). Within-group changes in HDL cholesterol, triacylglycerol or lipoprotein(a) concentrations did not differ. Similarly, within-group changes over time in plasma tocopherol and carotenoid concentrations did not differ between groups. Our findings suggest that bakery products are excellent carriers for phytosterols, and their consumption is associated with a decrease in total and LDL-C concentrations, with no changes in alpha-tocopherol and beta-carotene. The ability of bakery products to include sufficient quantities of beta-carotene to compensate for a potential deficiency, and the fact that their efficacy was not associated with the time of day at which they were consumed, are interesting findings.     

Quality of Life after Obesity Surgery, an Evidence-Based Medicine Literature Review: How to Improve Systematic Searches for Enhanced Decision-Making and Clinical Outcomes

Background: Research attests to the exponential sweep of clinical obesity in America. Obesity has become one of the most profound public health concerns, closely linked to increased morbidity, mortality, and social, occupational, and psychological discrimination. It is incumbent for specialists to design treatment and outcome analysis based accurately upon systematic research. Regulators, payors, and most notably, patients, need reliable and effective treatment to determine practical standards, manage cost of care, and protocols. Methods: A comprehensive evidence-based medicine (EBM) review was done of relevant research on quality-of-life (QoL) outcomes after obesity surgery. The Cochrane Collaboration was the EBM searching resource utilized for this project, accessed via the Internet. A systematic EBM search design was implemented. Results: In the search, QoL reported 3,234 hits, "obesity surgery" reported 33 hits, QoL and obesity surgery" reported 6 hits, and QoL and hypertension reported 288 hits. Conclusion: We found that a thorough EBM search can be achieved using the Cochrane Collaboration, which provides an efficient, effective and ethical means to enhance evidence-based clinical decision-making in treating severely obese surgery patients.     

Two nosocomial pertussis outbreaks and their associated costs - King County, Washington, 2004.

OBJECTIVE: Pertussis outbreaks in healthcare settings result in resource-intensive control activities, but studies have rarely evaluated the associated costs. We describe and estimate costs associated with 2 nosocomial pertussis outbreaks in King County, Washington, during the period from July 25 to September 15, 2004. One outbreak occurred at a 500-bed tertiary care hospital (hospital A), and the other occurred at a 250-bed pediatric hospital (hospital B). METHODS: We estimated the costs of each outbreak from the hospitals' perspective through standardized interviews with hospital staff and review of contact tracing logs. Direct costs included personnel time and laboratory and medication costs, whereas indirect costs were those resulting from hospital staff furloughs. RESULTS: Hospital A incurred direct costs of $195,342 and indirect costs of $68,015; hospital B incurred direct costs of $71,130 and indirect costs of $50,000. Cost differences resulted primarily from higher personnel costs at hospital A ($134,536), compared with hospital B ($21,645). Total cost per pertussis case was $43,893 for hospital A (6 cases) and $30,282 for hospital B (4 cases). Total cost per person exposed to a pertussis patient were $357 for hospital A (738 exposures) and $164 for hospital B (737 exposures). CONCLUSIONS: Nosocomial pertussis outbreaks result in substantial costs to hospitals, even when the number of pertussis cases is low. The cost-effectiveness of strategies to prevent nosocomial pertussis outbreaks, including vaccination of healthcare workers, should be evaluated.