Factors influencing exercise participation by clients in long-term care.

Lack of participation in regular physical activity by the frail elderly is associated with a decline in physical functioning and an inability to carry out activities of daily living. This in turn, poses greater demands on nursing care that may be required by the client. This study explored factors that influence exercise adherence in frail elderly clients who are living in a long-term care facility. Twelve long-term care clients (5 males and 7 females), aged 74-95 years, participated in the study. Participants were divided into two groups according to their activity patterns (sedentary controls and regular exercisers) and completed a brief questionnaire addressing factors that have been associated with exercise adherence. Data analysis revealed two key factors which determined whether or not clients participated in physical activity programs. The amount of social support provided by significant others and the extent of chronic pain experienced by the client were the best predictors of engagement in regular exercise. Incorporating an understanding of these factors into nursing practice can help the nurse encourage regular physical activity in patients who are living in a long-term care setting. This in turn will help the client maintain his or her ability to carry out activities of daily living.

Depression in the wives of nuclear submarine personnel.

The authors compared levels of depression among 24 wives of nuclear submarine personnel under conditions of husband-presence and husband-absence in a crossover research design. The wives had significantly higher depression scores under conditions of husband-absence on both the Zung Depression Scale and the Multiple Affect Adjective Checklist. The results are discussed in terms of the tremendous stresses imposed on the wives as a result of the nuclear submarine deployment schedule and the failure of the Navy and the spouses to recognize and reward the wives for their efforts.

Evaluation of level I and II axillary nodes included in the standard breast tangential fields and calculation of the administered dose: results of a prospective study.

PURPOSE: To evaluate if Level I and II axillary nodes are included in the standard breast tangential fields, and to calculate the dose administered. METHODS AND MATERIALS: In 35 patients treated with conservative surgery and axillary dissection, three clips were surgically positioned: one at the beginning of Level I, one between Level I and II, and another at the end of Level II. The breast was irradiated with two tangential fields. On simulation films, the volume between the clips was scored as "entirely included" or "not entirely included" in the treatment fields. Computed tomography (CT) scans were performed; CT data were imported into a treatment planning system, and three-dimensional plans were devised. Axillary Levels I and II were delineated on CT slices on the basis of anatomic landmarks. Fields and isodose curves previously obtained were superimposed to calculate the dose administered to the first two axillary node levels and to 90% of both volumes. RESULTS: On X-rays, the volume between clips corresponding to Level I was completely included in the medial field in 66.7% of cases and in the lateral field in 63.7% of cases, whereas the volume of Level II was entirely included in the medial field in 54.5% of cases and in the lateral field in 45.4% of cases. The median dose administered to Level I and II was 38.58 Gy +/- 11.01 (range 3.46-47.14) and 20.65 Gy +/- 14.07 (range 0.95-38.94), respectively. The median dose to 90% of both volumes of Level I and II was 6.75 Gy +/- 14.01 (range 1.9-39) and 1.75 Gy +/- 9.72 (range 0.8-29), respectively. CONCLUSION: The standard tangential fields do not entirely include Levels I and II axillary nodes.

Stress, social supports, and schizophrenic disorders: toward an interactional model.

The present article proposes an interactional model of schizophrenic disorders in which three parameters of stressors (e.g. stressor category, stressor content, stressor descriptors) interact with four parameters of social networks/supports (e.g. structure, interactional properties, qualitative properties, functional indices) to produce a stress state characterized by positions along three orthogonal dimensions: overload-underload, positive-negative affect, high arousal-low arousal. The stress state, it is speculated, is reciprocally related to various clinical dimensions, functional system impairments, quantitative response parameters, and qualitative response parameters which constitute the "schizophrenic" disorder. The basic point of the model is that the formative, precipitative, expressive, and maintaining forces of schizophrenic-type disorders are influenced by the simultaneous interaction of stressors, supports, and stress states.

Urbanization, mental health, and social deviancy. A review of issues and research.

This article reviews the international research literature on the relationship of urbanization, mental health, and social deviancy. Attention is called to the multidisciplinary and multisectoral nature of the topic, and to its associated definitional, conceptual, and methodological issues and challenges. Selected research literature on rural-urban differences in mental health and social deviancy is reviewed. There is little consensus on the causal relationship between urbanization, mental health, and social deviancy, although numerous environmental and social pathogenic processes have been posited and investigated. Data indicate rural and urban milieus can have both pernicious and salutary consequences and that more research is needed to specify critical etiological factors and their relationship to subpopulation characteristics. Suggestions for improving future research efforts are offered, including the use of more complex theoretical models, measurement indices, and data analysis procedures.

International consultation and the homogenization of psychiatry in Southeast Asia.

The nature of psychiatric care varies little among the capital cities of Southeast Asia. Differences that may exist are of degrees along a common dimension. Colonial forces from the past and contemporary diffusion of modern psychiatry have produced this remarkably uniform pattern of thought and treatment across divergent national and cultural boundaries. Our paper analyzes the homogenization of psychiatry in Southeast Asia in three ways. First, we examine international mental health education, consultation and collaboration as interlocking mechanisms for the transfer of psychiatric technology. Second, the indirect and undesirable consequences of the diffusion of psychiatric knowledge and practice are analyzed. Third, we pose recommendations for countering these unanticipated consequences through evaluation research, ethical guidelines, and educational and intervention practices that strengthen indigenous healing resources.

Regional node failure in patients with four or more positive lymph nodes submitted to conservative surgery followed by radiotherapy to the breast.

A retrospective analysis was conducted to evaluate the incidence of nodal failure in a subgroup of patients who had T1-T2 breast cancer and four or more positive nodes. Sixty-four 5 patients ranging in age from 29 to 73 years (median, 51) received conservative surgery followed by radiotherapy to the breast between November 1980 and May 1995. Adjuvant chemotherapy was administered to 56 patients, 27 of whom were also treated with tamoxifen, which was used alone in 5 patients. Three patients received no adjuvant treatment. Sixty-two patients are evaluable for regional node failure. There were 10 nodal failures, 4 in the axillary and 6 in the supraclavicular regions, in 9 patients, at a median of 56.5 and 27 months, respectively. There was no internal mammary node failure. Median follow-up was 72.6 months. The 10-year probability of developing axillary and supraclavicular failure is 13.9 +/- 7.7% and 10.5 +/- 4.1%, respectively. Prognosis was better for patients with axillary and breast recurrence and worse when relapse was in the supraclavicular region. On the basis of our results and data already published in premenopausal patients, we believe that radiotherapy to the supraclavicular region should be considered in patients with four or more positive axillary nodes, after a complete dissection.

Toxicity and activity of docetaxel in anthracycline-pretreated breast cancer patients: a phase II study.

Docetaxel has proven effective in advanced breast cancer. Myelosuppression and cumulative fluid retention syndrome are troublesome, potentially avoidable toxicities. In this consecutive cohort study, docetaxel (100 mg/m2 by 1 hour i.v. infusion, q3 weeks) activity and toxicity was explored in 56 anthracycline-pretreated patients (eligible: 55: median age: 51 years [range: 28-68 years]; median performance status: 0 [range: 0-3]) with metastatic breast cancer, using two different granulocyte colony-stimulating factor and steroid pre- and postmedication schedules. Twenty-nine patients (group A) received a 5-day oral prednisone premedication, and 26 (group B) received 4-day low-dose i.m. dexamethasone; group B patients also received prophylactic granulocyte colony-stimulating factor. All patients were evaluable for toxicity and 53 for response. Prophylactic granulocyte colony-stimulating factor significantly lowered the incidence of grade III-IV neutropenia and neutropenic fever (p = 0.0001 and 0.01, respectively). The incidence of moderate-severe fluid retention syndrome was lower in patients receiving i.m. dexamethasone (p = 0.08). Overall response rate was 53% (4 complete responses/24 partial responses, 95% confidence interval 39.4-66.2%); 32% have stable disease and 15% progressive disease. In 21 anthracycline-refractory/resistant patients, as well as in 10 paclitaxel-pretreated patients, the overall response rate was 50%. Docetaxel is highly active in anthracycline- and paclitaxel-pretreated metastatic breast cancer, with manageable toxicity. Optimal use of both granulocyte colony-stimulating factor support and steroid premedication deserves further investigation.

Counseling and psychotherapy with Japanese Americans: cross-cultural considerations.

The literature of the past two decades on Japanese-American culture, behavior, and mental health services and issues is reviewed. Counseling and psychotherapy with these clients are then discussed, taking into account traditional Japanese cultural values, with particular emphasis on verbal and nonverbal factors affecting therapeutic approaches and communication.

Attribution and serious mental illness: understanding multiple perspectives and ethnocultural factors.

Attributions regarding the nature, cause, and best treatment of mental health problems were examined in a total of 563 adults with serious mental illness from four ethnocultural groups, 185 family members, and 43 mental health practitioners. Attributions agreed in many areas, such as stress as a cause, and medical intervention and counseling as best treatment. Differences were found between the practitioner and other groups in attributions regarding the senses in the nature of mental illness, and in drugs and alcohol as a cause. The role of ethnicity was examined and treatment implications discussed.