Obesidade e hipertensão em adolescentes e adultos com deficiência intelectual / Obesity and hypertension in adolescents and adults with intellectual disability

Resumo Objetivo O objetivo deste estudo foi identificar as taxas de obesidade e hipertensão arterial em indivíduos com deficiência intelectual. Métodos Este estudo foi realizado com adolescentes e adultos com deficiência intelectual em três centros emIzmir, Turquia. O IMC dos adultos foi determinado de acordo com o Programa de Prevenção e Controle da obesidade da Turquia. O IMC dos adolescentes foi avaliado de acordo com as curvas de percentis de IMC para crianças turcas. Para a avaliação dos níveis de pressão arterial de adultos, foi utilizado o sistema de classificação determinado pela Sociedade Turca de Cardiologia. O diagnóstico da pressão sanguínea em adolescentes é diferente dos adultos. Em termos de idade e sexo, pressões arteriais sistólica e diastólica menores que o percentil 90 são considerados normais. Resultados Os valores médios dos adultos foram: altura de 166 ± 0,1 cm, peso de 71,7 ± 1,86 kg, pressão arterial sistólica de 120,8 ± 1,53 mmHg, pressão arterial diastólica de 74,8 ± 1,35 mmHg e IMC de 25,96 ± 5,98. Os valores médios dos adolescentes foram: IMC de 23,02 ± 6,3, pressão arterial sistólica de 117 ± 14,3 mmHg e diastólica de 70 ± 13,8 mmHg. Dentre os adultos, 37,3% estavam com peso normal e 28% estavam acima do peso. A análise do IMC dos adolescentes demonstrou que 46,1% estavam entre o 5ª e 85º percentis, 26,3% encontravam-se acima do percentil 95 e 18,4% estavam abaixo do 5º percentil. Dentre os adultos, 59,8% tinham pressão sistólica ótima e 77,5% tinham pressão diastólica ótima. Conclusão Os resultados deste estudo demonstram que as taxas de obesidade e hipertensão é elevada em adolescentes e adultos com deficiência intelectual e, portanto, estes indivíduos encontram-se em sério risco de desenvolver doença cardiovascular.

Abstract Objective The aim of this study is to determine the rate of obesity and hypertension in individuals with intellectual disability. Methods This study was carried out with the adolescents and adults with intellectual disability in three centres, in Izmir, Turkey. The BMI of the adults were classified according to the Turkey Obesity Prevention and Control Program. The BMIs of the adolescents were evaluated according to the BMI percentile curves for Turkish children. For the evaluation of blood pressure levels of adults, the classification system determined by the Turkish Society of Cardiology was used. Blood pressure diagnosis in adolescents is different from that in adults. In terms of age and gender, systolic and diastolic blood pressures lower than the 90th percentile are considered as normal. Results The mean measurements for adults were as follows: height 166 ± 0.1 cm, weight 71.7 ± 1.86 kg, systolic blood pressure 120.8 ± 1.53 mmHg, diastolic blood pressure 74.8 ± 1.35 mmHg, and BMI 25.96 ± 5.98. The mean measurements for adolescents were as follows: BMI 23.02 ± 6.3 systolic blood pressure 117 ± 14.3 mmHg and diastolic pressure 70 ± 13.8 mmHg. 37.3% of adults were of normal weight and 28% were overweight. Analysis of BMI of the adolescents demonstrated that 46.1% were between the 5th and 85th percentiles, 26.3% appeared above the 95th percentile and 18.4% were below the 5th percentile. Of the subjects, 59.8% had an optimal systolic pressure and 77.5% had an optimal diastolic pressure of adults. Conclusion The results of this study demonstrate that the rate of obesity and hypertension is high in adolescents and adults with intellectual disabilities and therefore, these individuals are at a serious risk of developing cardiovascular disease.

Examination of the Relationship Between Hopelessness Levels and Coping Strategies Among the Family Caregivers of Patients With Cancer.

BACKGROUND: Family caregivers who provide care for cancer patients may have to cope with a variety of physical, social, and economic problems during the caregiving process. A sense of hopelessness seems to lead to increasingly negative evaluations of new situations and less effective coping strategies. OBJECTIVE: The objective of the study was to examine the relationship between hopelessness and the coping strategies of the family caregivers of oncology patients. METHODS: This cross-sectional, descriptive correlational design study was carried out in the adult oncology unit and outpatient radiation oncology units of a university hospital in Turkey. The research sample was composed of 110 family caregivers. A sociodemographic data form, the Coping Stress Strategies Scale, and the Beck Hopelessness Scale were used in face-to-face interviews. RESULTS: Significant correlations were found between hopelessness and coping strategies. There was a positive correlation between hopelessness and the helpless approaches, which constitute a part of the emotion-focused coping strategies (r = 0.254, P < .01). There was a negative correlation between hopelessness and problem-focused coping strategies (optimistic approach and seeking social support) (r = -0.484, P < .01; r = -0.190, P < .05). CONCLUSION: In our study, we found that when the hopes of family caregivers are raised, they may adopt a more optimistic approach, and seek more social support, and display more effective coping strategies. IMPLICATIONS FOR PRACTICE: This study could be used to help develop nursing interventions and efficient coping strategies. It suggests how oncology nurses may support family caregivers to increase their level of hope.

An analysis of the cultural problems encountered during caregiving by the nurses working in two different regions of Turkey.

The aim of this study was to identify the cultural problems encountered during caregiving by the nurses working in two university hospitals located in western and eastern Turkey. This descriptive, comparative study was conducted between July 2008 and October 2009 with 338 nurses who volunteered to take part in the study. The study data were collected using an individual description questionnaire consisting of 10 questions and another questionnaire consisting of 14 questions to identify the cultural problems encountered by nurses when giving care. The study showed with respect to training received on transcultural nursing that only 59 nurses had this training, but the percentage was higher in the nurses working at the hospital in the west (54.2%) (P > 0.05). It was found that a large number of nurses in the sample group (n = 286) gave care to at least one individual from another culture, but the percentage was significantly higher in the nurses working in the west (56.7%) than in the nurses working in the east (43.3%) (P < 0.05). When the problems experienced by the nurses during caregiving because of cultural characteristics of patients were explored, it was found that they experienced problems mostly in 'communication', and the percentage of those having problems was higher in the nurses working in the west (60.8%) (P > 0.05). The problem experienced in this area was mostly because of the fact that patients 'did not speak Turkish' (63.8%). In conclusion, the nurses gave care to patients from different cultures, and most of them had trouble when giving care to patients from different cultures.

Determining the factors that affect breast cancer and self breast examination beliefs of Turkish nurses in academia.

PURPOSE: To define factors that affect the performance status of BSE and confidence of student nurses. MATERIALS AND METHODS: This descriptive study was conducted in the academic year 2010-2011 in a nursing faculty in I?zmir, Turkey. "Informative data form" and "Champion's Revised Health Belief Model Scale (CHBMS)" were used as data collection forms. RESULTS: The mean age of the participant nurses was 21.0±1.49. The mean CHMS scores of the student nurses were as follows: perceived susceptibility regarding breast cancer, 7.78±2.46; perceived seriousness regarding breast cancer, 22.4±5.43; perceived benefit regarding BSE application, 20.5±4.45; perceived barriers regarding BSE application, 23.8±7.13; perceived confidence regarding BSE application, 36.3±7.78; the mean score of health motivation sub-scale, 25.7±4.59; and mean of the total score of the scale, 36.5±15.01. CONCLUSIONS: The outcomes obtained in this study indicated the importance of better education to student nurses, who have a key role in teaching preventive health behaviour including BSE to society and other university students as colleagues.

A multicenter analysis of the use of complementary and alternative medicine in Turkish patients with rheumatoid arthritis: holistic nursing practice review copy.

The purpose of this study was to examine the complementary and alternative medicine (CAM) use in patients with rheumatoid arthritis living in different regions and cities of Turkey as well as the factors affecting the use of CAM modalities. Planned as a descriptive and cross-sectional study, this research was conducted as a study covering the rheumatology units of 10 university and 4 state hospitals in Turkey. A total of 594 patients meeting the research inclusion criteria comprised the sample. It was detected that 46.9% (n = 279) of the patients with rheumatoid arthritis whose average disease duration was 10.32 ± 9.05 years used CAM modalities. The most common 3 modalities used by these patients were herbs taken orally, nutritional supplements, and mind-body therapies, with rates of 54.5%, 41.2%, and 40.5%, respectively. It was determined that such variables as age, sex, marital status, education status, and economic situation did not affect the use of CAM (P > .05).

Research in cardiovascular care: a position statement of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology.

To deliver optimal patient care, evidence-based care is advocated and research is needed to support health care staff of all disciplines in deciding which options to use in their daily practice. Due to the increasing complexity of cardiac care across the life span of patients combined with the increasing opportunities and challenges in multidisciplinary research, the Science Committee of the Council on Cardiovascular Nursing and Allied Professionals (CCNAP) recognised the need for a position statement to guide researchers, policymakers and funding bodies to contribute to the advancement of the body of knowledge that is needed to further improve cardiovascular care. In this paper, knowledge gaps in current research related to cardiovascular patient care are identified, upcoming challenges are explored and recommendations for future research are given.

Retrospective analyses of reasons why children with newly diagnosed type 1 diabetes visit the emergency department.

OBJECTIVES: This retrospective study evaluates the clinical and laboratory values of children with type 1 diabetes at the time of first admission to the emergency service. Methods : It is a retrospective study to examine the clinical & laboratory findings of children visiting the emergency service between 2009 & 2012. The sample of the study included 111 children with newly diagnosed type 1 diabetes. Student t test and chi-square test were used in the analysis. RESULTS: HbA1c and blood glucose levels and ketoacidosis frequency was found significantly changed (p<0.05). It was detected that the frequency of ketoacidosis at the time of diagnosis was 60% in the children with type 1 diabetes while it was 45% in the second group and 34% in the third group. This difference at the time of admisison was found to be statistically significant (p<0.05). CONCLUSION: It became possible to diagnose children with type 1 diabetes much earlier over the course of time, and the number of patients that could be treated before severe diabetic ketoacidosis developed increased. This results is of great importance as it will provide a guide for all medical professionals including nurses.

The effects of self-pain management on the intensity of pain and pain management methods in arthritic patients.

The aims of this study were to investigate the effects of pain management education on the intensity of pain and frequency of utilization of pain management methods in two groups of patients with arthritis of different pathogenesis and clinical features, and to compare whether a significant difference existed between the two groups. The study was carried out between September 2007 and June 2008 on 30 female patients with gonarthrosis and 30 female patients with rheumatoid arthritis (RA) followed at the rheumatology outpatient clinic of a university hospital. Data on sociodemographic characteristics and those related with the illness were collected using a special survey. Each patient was given information about the features, causes, and treatment of the arthritis and how to cope with pain, emphasizing the importance of pain management methods. The intensity of pain and efficacy of pain management methods were assessed using the McGill Pain Questionnaire and the Pain Management Inventory at baseline and the second and sixth weeks after the education. The SPSS (v15.0) statistical package was used for statistical analysis. After education, significant improvements in pain intensity scores compared with baseline scores were observed in both groups (p < .05), and there was no significant difference between the RA and gonarthrosis groups. Among the various pain management methods, the education program led to significantly more utilization of massaging the painful area, exercising, and using complementary methods to control stress in both groups of patients, and there was no significant difference between the groups. In conclusion, the pain management education given in this study alleviated the intensity of pain and significantly increased the use of some pain management methods in both gonarthrosis and RA cases.

Lifestyle behaviors and early diagnosis practices of cancer patients.

BACKGROUND: The aim was to determine the lifestyle behaviors and the practices for early diagnosis of cancer of cancer patients. MATERIALS AND METHODS: A descriptive cross-sectional design was used for this study. The sample consisted of 222 patients with a diagnosis of cancer (non-random sample method). Ethical permission was obtained of the Non-interventional Research Ethics Committee of our Institution. Values of p<0.05 were accepted as statistically significant. RESULTS: It was observed that 54.4% of the patients had never performed breast self-examination, 60.8% had never had a mammography, and 71.2% had never had a Pap smear. Sixty-six point two percent of patients had never had screening for colon cancer within the past ten years. GIS cancers were higher in smokers and ex-smokers (p=0.005), in drinkers and in ex-drinkers (p=0.000). The breast cancer rate was higher in obese people (p=0.019). CONCLUSIONS: The results of this study provide information on the healthy lifestyle behavior of cancer patients before their diagnosis, and their use of early diagnosis practices. The important aspect of this study is to extend cancer patients' period of life after the diagnosis and treatment process, to make them conscious of risky lifestyle and nutritional behavior so that they can maintain a high quality of life, and to start initiatives in this direction that would ensure changes in behavior.

Investigation into the use of complementary and alternative medicine and affecting factors in Turkish asthmatic patients.

AIMS: The purpose of this study was to examine the frequency of complementary and alternative medicine usage in asthmatic patients living in the west of Turkey, the most frequently used complementary and alternative medicine methods and socio-demographic factors affecting this and factors related to the disease. BACKGROUND: While the rate of complementary and alternative medicine usage in asthmatic patients and the reasons for using it vary, practices specific to different countries and regions are of interest. Differing cultural and social factors even in geographically similar regions can affect the type of complementary and alternative medicine used. METHODS: Two hundred asthmatic patients registered in the asthma outpatient clinic of a large hospital in Turkey and who had undergone pulmonary function tests within the previous six months were included in this study, which was planned according to a descriptive design. The patients filled out a questionnaire on their demographic characteristics and complementary and alternative medicine usage. RESULTS: The proportion of patients who reported using one or more of the complementary and alternative medicine methods was 63·0%. Of these patients, 61·9% were using plants and herbal treatments, 53·2% were doing exercises and 36·5% said that they prayed. The objectives of their use of complementary and alternative medicine were to reduce asthma-related complaints (58%) and to feel better (37·8%). The proportion of people experiencing adverse effects was 3·3% (n = 4). Factors motivating asthmatic patients to use complementary and alternative medicine were the existence of comorbid diseases and a long period since diagnosis (p < 0·05). No statistically significant difference was found between the use of complementary and alternative medicine and the severity of the disease, pulmonary function test parameters, the number of asthma attacks or hospitalisations because of asthma within the last year (p > 0·05). RELEVANCE TO CLINICAL PRACTICE: Understanding by nurses of the causes and patterns of the use of complementary and alternative medicine in asthmatic patients helps them in directing patient care and patient safety. Nurses should conduct comprehensive diagnostics in the light of complementary and alternative medicine use, and they should be aware of the potential risks.

Case management in care of Turkish rheumatoid arthritis patients.

This study examined the effectiveness of a case management (CM) intervention in the care of patients with rheumatoid arthritis (RA) as a pilot study in a teaching hospital in Turkey. Two groups were compared with respect to disability, quality of life, cost, and patient satisfaction: RA patients who received CM plus usual nursing care and RA patients who received usual nursing care alone. All patients underwent follow-up interviews at 3 and 6 months after being discharged from the hospital. Disability scores were significantly better in the RA group receiving CM, but there were no significant differences between the two groups with regard to quality of life, patient satisfaction, and total healthcare costs. Using CM in the care of patients with RA may favorably affect disease-related outcomes.

Reliability and validity of the Turkish version of the Memorial Symptom Assessment Scale in cancer patients.

AIM: The Memorial Symptom Assessment Scale (MSAS) is a multidimensional tool developed to evaluate measure the prevalence, characteristics and distress of common symptoms related to cancer. A validated Turkish version has now become available. The aim of this study was to evaluate its reliability and validity. METHODS: One hundred-twenty patients were included into this study. The MSAS, The Rotterdam Symptom Checklist (RSCL), and Karnofsky Performance Status Scale (KPSS) were used for data collection. Content and criterion validities were examined. Reliability analyses of the MSAS were performed using internal consistency reliability and test-retest reliability. RESULTS: The most frequently reported symptom (90%) was problems with sexual interest or activity. Item-total correlations ranged between 0.03 and 0.64. There was a high correlation between total MSAS and the RSCL (r=0.875, p<0.01). The internal consistency reliabilities of subscales of the MSAS and total MSAS were moderately high, with Cronbach alpha coefficients ranging from 0.71 to 0.84. The MSAS's test - re-test reliability was 0.78. CONCLUSION: The MSAS for cancer patients was determined to be a valid and reliable instrument for the use in the Turkish population. It is recommended that the MSAS-Turkish version can be used as a tool for comprehensive symptom assessment in planning nursing care for cancer patients.

[Evaluation of anxiety and depression levels in patients with myocardial infarction]. / Miyokart enfarktüslü hastalarda anksiyete ve depresyonun incelenmesi.

OBJECTIVES: Patients with myocardial infarction (MI) may experience anxiety and depression. This study was designed to determine anxiety and depression levels in patients with MI. STUDY DESIGN: The study included 506 patients (199 women, 307 men; mean age 55.7+/-6.9 years) who were admitted to the cardiology department for MI. Data were collected using a questionnaire to identify patient characteristics and the Hospital Anxiety and Depression Scale (HADS). The HADS has been validated as a sensitive screening tool for anxiety and depression in MI patients in the Turkish population. RESULTS: Clinically severe anxiety was found in all the patients (100%). Depression scores showed a clinically normal level in 45 patients (8.9%), borderline level in 289 patients (57.1%), and severe level in 172 patients (34%). The mean HADS score was 11.4+/-2.9, being 12.2+/-4.1 and 10.6+/-4.1 for anxiety and depression, respectively. Among patient characteristics, age was significantly associated with both anxiety and depression subscales (p<0.001), and education level (p<0.05), total family income (p<0.01), health insurance (p<0.05), and the number of myocardial infarctions (p<0.05) were significantly associated with the depression subscale. In regression analysis, age (beta=-0.128), education level (beta=0.082), and working status (beta=-0.79) independently affected both anxiety and depression, and total family income (beta=-0.128) and health insurance (beta=-0.086) significantly affected depression. CONCLUSION: Our data suggest that planning nursing interventions to decrease anxiety and depression levels and implementation of cardiac rehabilitation programs are of particular importance in patients with MI.

The relationship between disability and self-care agency of Turkish people with rheumatoid arthritis.

AIM: This study aims to determine the relationship between disability levels and self care agency scores in Turkish patients with rheumatoid arthritis and to investigate the factors affecting them. BACKGROUND: Self-care agency is the complex acquired ability to meet one's constant requirements for care that regulates life processes, maintains or promotes the integrity of human structure, functioning and development, and promotes well-being. DESIGN AND METHODS: Forty-three consecutive patients with Rheumatoid Arthritis (M/F: 11/32; mean age 49.53 +/- 13.37 years; disease duration 118.32 +/- 76.55 months), being followed up by Ege University Rheumatology Outpatient Department and all fulfilling ACR 1987 criteria were included in this study. Data collection instruments used in this study were Informative-Demographic Data Form, Health Assessment Questionnaire (including disability index and pain scale) and Self-as-Carer Inventory. RESULTS: The mean disability index, the mean pain score and the mean self-care agency score of patients were 0.53 (SD 0.45), 1.48 (SD 0.74) and 80.95 (SD 27.80) were respectively. Self-care agency of patients found moderate level. It was found that a positive correlation between the disability index and the self-care agency scores (r = 0.488; p < 0.01). It was found that in male (t = 0.907; p = 0.000), in patients graduate from university (F = 0.271; p = 0.001), the self-care agency was better than other patients. CONCLUSION: In conclusion we found that in Turkish patients with Rheumatoid Arthritis, the higher the disability rate was, the lower the self-care agency score was. RELEVANCE TO CLINICAL PRACTICE: Disability, pain and their impact on self-care agency should be focused on in everyday care for Rheumatoid Arthritis patients. These areas are most important in nursing care and should be considered while organizing the medical treatment and rehabilitation programme.

[The use of complementary and alternative treatment in patients with asthma]. / Astimli hastalarda tamamlayici ve alternatif tedavi kullanimi

Complementary and alternative medicine (CAM) therapies such as herbal therapy, acupuncture, yoga, chiropractic, relaxation techniques, nutrition and dietary supplements, continue to gain popularity as modalities for treatment of asthma. A number of study in this area has shown frequently used CAM therapies by patients with asthma. It has found that parents who have children with asthma preferred commonly CAM therapies such as massage, relaxation techniques, diet and vitamin and that adult patients with asthma used commonly nutrition and diet supplements, herbal therapies and homeopathy. Because of many studies had weak methodology and small sample; it hasn't exposed entirely effectiveness of CAM therapies in asthma treatment. In this respect, it is required qualitative researchs with strong methodology. Furthermore; it is suggested that health professionals have to much knowledge about CAM therapies in asthma and they have to an active role in development guidelines related to CAM interventions.