Factors influencing weight gain after renal transplantation.

Weight gain following renal transplantation occurs frequently but has not been investigated quantitatively. A retrospective chart review of 115 adult renal transplant recipients was used to describe patterns of weight gain during the first 5 years after transplantation. Only 23 subjects (21%) were overweight before their transplant. Sixty-six subjects (57%) experienced a weight gain of greater than or equal to 10%, and 49 subjects (43%) were overweight according to Metropolitan relative weight criteria at 1 year after transplantation. There was an inverse correlation between advancing age and weight gain, with the youngest patients (18-29 years) having a 13.3% weight gain and the oldest patients (age greater than 50 years) having the lowest gain of 8.3% at 1 year (P = 0.047). Black recipients experienced a greater weight gain than whites during the first posttransplant year (14.6% vs. 9.0%; P = 0.043), and maintained or increased this difference over the 5-year period. Men and women experienced comparable weight gain during the first year (9.5% vs. 12.1%), but women continued to gain weight throughout the 5-year study (21.0% total weight gain). The men remained stable after the first year (10.8% total weight gain). Recipients who experienced at least a 10% weight gain also increased their serum cholesterol (mean 261 vs. 219) and triglyceride (mean 277 vs. 159) levels significantly, whereas those without weight gain did not. Weight gain did not correlate with cumulative steroid dose, donor source (living-related versus cadaver), rejection history, pre-existing obesity, the number of months on dialysis before transplantation, or posttransplant renal function. Posttransplant weight gain is related mainly to demographic factors, not to treatment factors associated with the transplant. The average weight gain during the first year after renal transplantation is approximately 10%. This increased weight, coupled with changes in lipid metabolism, may be significant in terms of altering risk from cardiovascular morbidity.

The use of dietary restrictions in malnourished nursing home patients.

OBJECTIVE: To evaluate the dietary prescriptions of nursing home patients who show evidence of malnutrition. DESIGN: A descriptive chart review. SETTING: Four chronic care facilities in Milwaukee, Wisconsin. PATIENTS: A total of 336 charts were randomly selected from the four facilities. Analysis was done on the 217 charts that included a recorded serum albumin. MAIN OUTCOME MEASURES: Serum albumin, height, most recent weight, weight recorded 6 months previously, major diagnoses, and current diets were recorded. Average weight change per month and body mass index were calculated. RESULTS: In 109 of the 217 patients, the serum albumin was less than 3.5 g/dL. 75.2 percent of hypoalbuminic patients were on some sort of dietary restriction, including caloric restriction in 18% and sodium restriction in 35%. Sixty-six of the 217 patients had an average weight loss of greater than 1 pound per month, and 59% of this group were on dietary restrictions, with 21% on sodium restriction and 20% on limited calories. CONCLUSIONS: Malnutrition is a common problem in the nursing home population. A restricted diet is one possible factor that might contribute to this. While this study does not prove a causal relationship between a restricted diet and malnutrition, it would seem inappropriate that most patients with evidence of malnutrition are on diets that might discourage nutrient intake.

Relationship between neonatal birth weight and maternal plasma amino acid profiles in lean and obese nondiabetic women and in type I diabetic pregnant women.

Profiles of hemoglobin A1c (HbA1c) and concentrations of plasma glucose and 18 plasma amino acids were obtained in ten nonobese, insulin-dependent type I diabetic women, in 9 age- and weight-matched normal women and in ten obese nondiabetic women throughout pregnancy and postpartum. In late gestation, the period of maximum fetal growth, average HbA1c, plasma glucose, and total amino acid concentrations in diabetic mothers were significantly elevated above lean control values. No differences existed between the obese and lean control groups. Lean diabetic mothers also had significantly heavier babies (mean +/- SEM) relative to the 50th percentile for gestational age and sex (119 +/- 9%) than did the lean control group (94 +/- 3%, P less than .05). Relative birth weights among control lean and obese mothers did not differ significantly (94 +/- 3% v 104 +/- 5%). Late pregnancy profiles of HbA1c and average plasma glucose did not correlate with relative weight of neonates whereas average total plasma amino acids and six individual amino acids did correlate with this parameter. These data suggest that maternal plasma amino acid concentrations may influence fetal weight generally and may have an important role in the development of fetal macrosomia in diabetic pregnancies.

Personal and environmental influences on nursing home satisfaction.

Data were collected from the administrator, staff, and a sample of 289 residents in 51 nursing homes in order to assess the influence of organizational factors on residents' satisfaction with the nursing home. Longevity of personnel, level of benefits, wages for nursing assistants and their perception of the charge nurse's fairness and competence as well as the degree of personalization of residents' rooms were all related to residents' satisfaction with the nursing home.

The association of smoking with clinical indicators of altered sex steroids--a study of 50,145 women.

This study was designed to test the association of smoking with four clinically apparent conditions that may be related to altered sex steroids: natural and induced menopause, infertility, oligomenorrhea, and hirsutism. Data were obtained from the personal inventories of 50,145 women ages 20-59 years in TOPS, a weight reduction program. The age-adjusted odds ratios of each condition for heavy smokers compared with nonsmokers were 1.59 for natural menopause, 1.49 for induced menopause, 1.35 for infertility, 1.30 for oligomenorrhea among women younger than 40 years, 1.63 for oligomenorrhea among women 40-49 years, and 1.54 for hirsutism (P less than .05 for oligomenorrhea and P less than .001 for all other risks). The odds ratios were not substantially changed after adjustment for obesity, parity, and husband's education level. These results suggest that smoking may affect the ovaries or hormone metabolism, or both, with medical and cosmetic consequences.

Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses.

BACKGROUND: High levels of stress and the challenges of meeting the complex needs of critically ill children and their families can threaten job satisfaction and cause turnover in nurses. OBJECTIVE: To explore the influences of nurses' attributes, unit characteristics, and elements of the work environment on the job satisfaction of nurses in pediatric critical care units and to determine stressors that are unique to nurses working in pediatric critical care. METHOD: A cross-sectional survey design was used. The sample consisted of 1973 staff nurses in pediatric critical care units in 65 institutions in the United States and Canada. The following variables were measured: nurses' perceptions of group cohesion, job stress, nurse-physician collaboration, nursing leadership, professional job satisfaction, and organizational work satisfaction. RESULTS: Significant associations (r = -0.37 to r = -0.56) were found between job stress and group cohesion, professional job satisfaction, nurse-physician collaboration, nursing leadership behaviors, and organizational work satisfaction. Organizational work satisfaction was positively correlated (r = 0.35 to r = 0.56) with group cohesion, professional job satisfaction, nurse-physician collaboration, and nursing leadership behaviors. Job stress, group cohesion, job satisfaction, nurse-physician collaboration, and nursing leadership behaviors explained 52% of the variance in organizational work satisfaction. Dealing with patients' families was the most frequently cited job stressor. CONCLUSIONS: Job stress and nursing leadership are the most influential variables in the explanation of job satisfaction. Retention efforts targeted toward management strategies that empower staff to provide quality care along with focal interventions related to the diminishment of stress caused by nurse-family interactions are warranted.

Concerns of childbearing women: a Maternal Concerns Questionnaire as an assessment tool.

OBJECTIVE: To determine if a tool measures maternal concerns in different populations of women. DESIGN: Secondary analysis of data in five master's theses using the Maternal Concerns Questionnaire. SETTING: Data were collected in postpartum units and homes. Populations were composed of rural and urban women. PARTICIPANTS: Five groups of childbearing women (N = 187) during the antepartum or postpartum periods. MAIN OUTCOMES: Subjects responded to 46 items related to concerns about themselves and their infants, partners, families, and community activities. RESULTS: The Maternal Concerns Questionnaire discriminates specific concerns between populations. CONCLUSIONS: The Maternal Concerns Questionnaire can be used in clinical practice to identify the specific concerns of mothers. The information gained can be used to individualize nursing-care plans and to measure outcomes.

Stress and coping in fathers of newborns: comparisons of planned versus unplanned pregnancy.

The purpose of this survey was to identify stresses and coping styles in fathers of newborns, and to explore if these vary according to pregnancy planning. Data from 69 subjects were collected using the Ireton Personal Inventory and the Jalowiec Coping Scale. The most common and least often sources of stress or worry were reported. Fathers' predominant mode of coping was problem oriented. Compared to fathers with planned pregnancies, fathers with unplanned pregnancies were found to be significantly more stressed about numerous issues as well as feeling powerless in adapting to the arrival of a new infant. Implications for practice and research are explored.

PIP: The aim was to assess among new fathers their stresses and coping styles and to ascertain whether there was different behavior in planned versus unplanned pregnancies. The study was confined to 69 fathers with 4-6 week health infants and no other children less than one year old, and who had no prior history of institutionalization for mental health problems. Fathers were recruited from the community at large. The sample included 68% (47) planned and 32% (22) unplanned pregnancies. The mean age of the fathers was 29 years. There was wide spectrum of income levels. 88% were White, 5% Black, 2% Asian, 3% Hispanic, and 2% American Indian. 90% were married. Marriage duration averaged 2.5 years. The Ireton Personal Inventory and the Jalowiec Coping Scale were administered at the School of Nursing at the University of Wisconsin-Milwaukee. The results indicated that the stress centered around work, family health, finances, and children. Friendships and marital situation held the least stress. Significantly higher levels of stress were reported by fathers with unplanned pregnancies; subjects with unplanned pregnancies reported stress with finances, living situation, marital situation, sex, recreation, and friendships. The most common coping strategies were trying to control a situation, thinking through ways to solve the problem, finding out more about the situation, setting goals, and actively trying to change the situation. Few used the following coping strategies: taking drugs, getting mad, feeling hopeless, drinking, crying/getting depressed, or blaming others. The Jalowiec subscales identified problem-oriented, tension-modulating, and other directed styles of coping, which were similar for all fathers. Fathers did show differences on feeling powerless; fathers with unplanned pregnancies had higher scores on the powerless subscales. These findings suggest that fathers may suffer stresses after childbirth, but not (as reported) of crisis proportions. Fathers of unplanned pregnancies are clearly more at risk of stress due to feelings of powerlessness and in adapting to a newborn. Longitudinal research should be directed to how stress and coping changes over time and whether attachment to the child is affected. Nurses should be trained to assess fathers' stresses during the pregnancy, as a means of helping fathers cope later.

Nurse practitioner student prescriptive patterns.

As employment of nurse practitioners (NPs) increases in health care systems, there is a need to have current data on their prescribing practices and patterns, and to implement a system for updating such data. This study reports prescriptive data based upon 10,421 primary care visits conducted by 55 family NP students over a 15-month period in 1997 and 1998. Numbers of over-the-counter drugs taken regularly, prescription drugs currently prescribed and prescription drugs prescribed or refilled at the visit were recorded in addition to types of drugs, compliance issues, diagnoses rendered and sociodemographic information. Individual student data were aggregated and analyzed using Epi Info (Epidemiology Program Office of the Centers for Disease Control) and SPSS-PC. Results identified that: 1) the majority of patient visits involved the prescription of 1-2 drugs (88%); 2) major compliance issues included financial concerns, knowledge deficits, and complexity/demands of treatment; 3) commonly rendered diagnoses at drug visits for chronic conditions were hypertension and diabetes; for acute conditions, otitis sinusitis and upper respiratory infections; 4) anti-microbial agents, drugs used for relief of pain, and cardiovascular drugs account for 60% of drug mentions; and 5) the numbers of drugs prescribed or refilled at visits were similar by type of preceptor, except fewer single drugs were prescribed or refilled at visits supervised by nurse preceptors. Findings are discussed relative to deepening the understanding of advanced practice nursing education and the prescribing practices of NP students and their preceptors.

An intervention to increase coping and reduce health care utilization for school-age children and adolescents with sickle cell disease.

The purpose of this study was to examine whether coping with pain changed immediately and one year after a self-care intervention for school-age children and adolescents with sickle cell disease (SCD). Sixty-five children and 32 adolescents attended an educational program for living with SCD. They were then randomly assigned to relaxation, art therapy or attention-control groups. Coping was measured before, after the intervention, and 12 months later. Thirty-three children and 14 adolescents completed the one year follow-up. Although there was no significant increase in the overall number of coping strategies school-age children and adolescents used from baseline to 12 months, there was a significant increase in those strategies specifically targeted by the intervention. For adolescents, there was a significant increase in the total number of coping scores used before the intervention and one year later. When compared to well African-American adolescents, overall coping scores in this sample were significantly lower. Health care utilization related to clinic visits, emergency department visits and hospitalizations decreased significantly for all participants in the study.

Urinary incontinence: treatments, interventions, and outcomes.

The central theme of this article is the development of clinical outcomes and interventions by CNSs to enhance the quality of care provided by nurses. This was done using findings from three funded research projects conducted by the authors. The outcomes begin with measurable nursing diagnoses and continue with searches for remedial risk factors, assessment, and remedies. The interventions encourage responsible behaviors by elders that are individualized prevention and/or treatments for a given diagnosis. A brief synopsis of the research results is included.

Knowledge, group-based medical mistrust, future expectations, and perceived disadvantages of medical genetic testing: perspectives of Black African immigrants/refugees.

BACKGROUND: Reasons for low participation of ethnic minorities in genetic studies are multifactorial and often poorly understood. Based on published literature, participation in genetic testing is low among Black African immigrants/refugees although they are purported to bear disproportionate disease burden. Thus, research involving Black African immigrant/refugee populations that examine their perspectives on participating in genetic studies is needed. OBJECTIVES: This report examines and describes the knowledge of medical genetics, group-based medical mistrust, and future expectations of genetic research and the influence of these measures on the perceived disadvantages of genetic testing among Black African immigrants/refugees. METHODS: Using a cross-sectional survey design, a nonprobability sample (n = 212) of Black African immigrants/refugees was administered a questionnaire. Participants ranged in age from 18 to 61 years (mean = 38.91, SD = 9.78). The questionnaire consisted of 5 instruments: (a) sociodemographic characteristics, (b) Knowledge of Medical Genetics scale, (c) Group-Based Medical Mistrust Scale, (d) Future Expectations/Anticipated Consequences of Genetics Research scale, and (e) Perceived Disadvantages of Genetic Testing scale. RESULTS: Participants were concerned that genetic research may result in scientists 'playing God,' interfering with the natural order of life. In multivariate analyses, the perceived disadvantages of genetic testing increased as medical mistrust and anticipated negative impacts of genetic testing increased. Increase in genetic knowledge contributed to a decrease in perceived disadvantages. CONCLUSIONS: Our findings suggest that recruitment of Black African immigrants/refugees in genetic studies should address potential low knowledge of genetics, concerns about medical mistrust, the expectations/anticipated consequences of genetic research, and the perceived disadvantages of genetic testing.

Single-protein nanomechanical mass spectrometry in real time.

Nanoelectromechanical systems (NEMS) resonators can detect mass with exceptional sensitivity. Previously, mass spectra from several hundred adsorption events were assembled in NEMS-based mass spectrometry using statistical analysis. Here, we report the first realization of single-molecule NEMS-based mass spectrometry in real time. As each molecule in the sample adsorbs on the resonator, its mass and position of adsorption are determined by continuously tracking two driven vibrational modes of the device. We demonstrate the potential of multimode NEMS-based mass spectrometry by analysing IgM antibody complexes in real time. NEMS-based mass spectrometry is a unique and promising new form of mass spectrometry: it can resolve neutral species, provide a resolving power that increases markedly for very large masses, and allow the acquisition of spectra, molecule-by-molecule, in real time.

Differences in anxiety and role experiences between three age groups of women with heart disease.

Anxiety and role experiences in women may be related to age, developmental changes, social roles, and life circumstances such as cardiac disease. One hundred fifty-five women participated in a cross sectional survey on anxiety and role experiences in early middle-age, midlife, and elderly women after heart surgery. MANOVA analysis revealed significant differences for anxiety and role experiences by age. Compared with older women, early middle-age women had lower balance between role rewards and concerns and a poorer match between ideal and actual role function, which may be a contributing factor for their increased anxiety.

A computerized system for tracking practice and prescriptive patterns of family nurse practitioner students.

Decisions about the fit between advanced practice nursing curricula and the real world of primary care practice should be based on data and not on intuition. The purpose of this article is to describe a computerized database system that can be used to: 1) track practice (including prescribing) patterns of nurse practitioner (NP) students; 2) address data issues that commonly arise; and 3) describe NP students' practice during their education to prospective employers. The database system uses both the Family Nurse Practitioners Log (FNPLOG), a faculty-developed software program, and Epi Info, a companion public domain software program. Variables are categorized as being related to sociodemographic, diagnostic, or prescriptive components of primary care. The system provides a simple, efficient, and feasible way of computerizing, analyzing, and evaluating students' clinical experience and practice patterns. The implications for advanced practice nursing education will be illustrated along with other potential uses of the database system.

Use of the nursing minimum data set to describe nursing interventions for select nursing diagnoses and related factors in an acute care setting.

This study describes the prevalence of nursing interventions across six nursing diagnoses and their related factors using the framework of the Nursing Minimum Data Set (NMDS). Six nursing diagnoses (pain, potential for injury, anxiety, decreased cardiac output, potential for infection, and knowledge deficit) were among the most prevalent in an acute care setting studied in 1991. The NMDS and a nursing information system using standardized classification systems for nursing diagnoses and interventions provided an opportunity to describe nursing practice. Multiple related factors were identified across all six nursing diagnoses; three or four were selected frequently within each diagnostic category. The related factors also influenced the selection of interventions. Implications for the development of nursing classification systems and recommendations for further research are described.

Relationship of body fat distribution to blood pressure, carbohydrate tolerance, and plasma lipids in healthy obese women.

In 110 obese, healthy women, a relationship was sought between distribution of body fat and blood pressure, glucose tolerance, plasma insulin, and fasting plasma lipid and serum uric acid concentrations. The index of body fat distribution was the ratio of waist circumference to hips circumference (WHR). The WHR range in this group was 0.5 to 0.99, with a median value of 0.78. Positive, significant correlations were found between WHR and both systolic and diastolic blood pressure and between WHR and the total integrated plasma glucose and insulin responses during 4 hr oral glucose tolerance tests. No relationship was found between WHR and age, the degree of obesity as defined by the weight-to-height ratio, or concentrations of fasting plasma free fatty acids, plasma triglyceride, plasma cholesterol, or serum uric acid. Subsequently, 27 women in the highest quartile of the WHR range (0.83 to 0.99) were compared to 28 age- and weight-matched subjects in the lowest quartile of WHR (0.5 to 0.73). Women in the highest quartile had systolic and diastolic blood pressure as well as total plasma glucose and insulin responses during glucose tolerance tests that significantly exceeded mean values of subjects in the lowest quartile. We conclude that in healthy, obese women, a continuum exists that relates increasing fat accumulation in the upper body to progressively higher blood pressure, reduced carbohydrate tolerance, and higher plasma insulin concentrations. These changes occurred independently of age of degree of obesity in this population.

The association of obesity with joint pain and osteoarthritis in the HANES data.

Data from 4225 persons from the National Health and Nutrition Examination Survey (HANES) was used to determine whether obesity was associated with osteoarthritis (OA) or joint pain. Subjects were divided into four groups on the basis of sex and race. We found that obesity was associated with OA of the knee for each sex/race group (p less than 0.01). The association was strongest for women, and it was present even for subjects without evidence of knee pain on physical examination. Frame size was not significantly associated with OA of the knee. Relative weight was weakly associated with OA of the hips in white women and nonwhite men but not significantly associated with OA of the sacroiliac joint. Diabetes did not seem to be an important risk factor for OA. These results suggest that the additional mechanical stress resulting from obesity is the principal reason for the association between obesity and OA.