Understanding symptom experiences of muscle tightness from patients' and clinicians' perspectives.

AIMS AND OBJECTIVES: The purpose of this study was to determine how patients' symptom experiences of muscle tightness correlate with examiner assessments. To address this question, we (1) obtained the vocabularies used by patients and examiners to describe muscle tightness, (2) correlated patient- reported Visual Analog Scale ratings for locations of muscle tightness on a body diagram and (3) explored the similarities and differences between patient and examiner evaluation of muscle tightness analytically and graphically. BACKGROUND: Symptoms of muscle tightness are common complaints that occur due to musculoskeletal and neuromusculoskeletal injuries. Terms such as muscle tightness are often intermingled with other conditions including muscle tension, muscle spasticity and muscle rigidity. Discrepancies between patients and clinicians understanding of similar symptoms have been reported in the literature. DESIGN: A concurrent exploratory mixed methods design was used. METHOD: Fifty-seven participants (six physical therapists, 51 patients) participated. Participants provided semi-structured interviews, ratings through Visual Analog Scale and concurrently provided the words used to describe muscle tightness. Patients also provided the location of muscle tightness on a body diagram. Content analysis and hierarchical linear modelling were used for data analysis. RESULTS: The patients' vocabularies contained more sensory and pain experiences when compared to the clinicians' vocabularies. Examiners and patients ratings were variable (standard deviation >20) and contained discrepancies. Stress played a role in the symptom experience of muscle tightness. Examiners tended to focus on patients' chief complaints, while patients reported their symptoms from a whole-body perspective. CONCLUSIONS: Symptom experiences of muscle tightness can occur with or without pain. Use of complementary therapy and development of an objective tool that accounts for patients' sensory experiences is warranted. RELEVANCE TO CLINICAL PRACTICE: Findings from this study indicate that in addition to all other available treatments options, nurses must also educate patients about correct posture alignment, breathing exercises and stress management.

Universal Pressure Ulcer Prevention Bundle With WOC Nurse Support.

PURPOSE: This study examined the effectiveness of a universal pressure ulcer prevention bundle (UPUPB) applied to intensive care unit (ICU) patients combined with proactive, semiweekly WOC nurse rounds. The UPUBP was compared to a standard guideline with referral-based WOC nurse involvement measuring adherence to 5 evidence-based prevention interventions and incidence of pressure ulcers. DESIGN: The study used a quasi-experimental, pre-, and postintervention design in which each phase included different subjects. Descriptive methods assisted in exploring the content of WOC nurse rounds. SUBJECT AND SETTING: One hundred eighty-one pre- and 146 postintervention subjects who met inclusion criteria and were admitted to ICU for more than 24 hours participated in the study. The research setting was 3 ICUs located at North Memorial Medical Center in Minneapolis, Minnesota. METHODS: Data collection included admission/discharge skin assessments, chart reviews for 5 evidence-based interventions and patient characteristics, and WOC nurse rounding logs. Study subjects with intact skin on admission identified with an initial skin assessment were enrolled in which prephase subjects received standard care and postphase subjects received the UPUPB. Skin assessments on ICU discharge and chart reviews throughout the stay determined the presence of unit-acquired pressure ulcers and skin care received. Analysis included description of WOC nurse rounds, t-tests for guideline adherence, and multivariate analysis for intervention effect on pressure ulcer incidence. Unit assignment, Braden Scale score, and ICU length of stay were covariates for a multivariate model based on bivariate logistic regression screening. RESULTS: The incidence of unit-acquired pressure ulcers decreased from 15.5% to 2.1%. WOC nurses logged 204 rounds over 6 months, focusing primarily on early detection of pressure sources. Data analysis revealed significantly increased adherence to heel elevation (t = -3.905, df = 325, P < .001) and repositioning (t = -2.441, df = 325, P < .015). Multivariate logistic regression modeling showed a significant reduction in unit-acquired pressure ulcers (P < .001). The intervention increased the Nagelkerke R-Square value by 0.099 (P < .001) more than 0.297 (P < .001) when including only covariates, for a final model value of 0.396 (P < .001). CONCLUSION: The UPUPB with WOC nurse rounds resulted in a statistically significant and clinically relevant reduction in the incidence of pressure ulcers.

A clinic-based youth development program to reduce sexual risk behaviors among adolescent girls: prime time pilot study.

Multifaceted, sustained efforts are needed to reduce early pregnancy and sexually transmitted diseases among high-risk adolescents. An important area for research is testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have rigorously evaluated a dual approach of building protective factors while addressing risk. This article presents findings from a pilot study of Prime Time, a clinic-based youth development intervention to reduce sexual risk behaviors among girls at risk for early pregnancy. Girls aged 13 to 17 years meeting specified risk criteria were assigned to Prime Time treatment groups. The Prime Time intervention included a combination of case management services and peer leadership groups. Participants completed self-report surveys at baseline, 12 and 18 months following enrollment. At 12 months, the intervention group reported significantly fewer sexual partners than the control group. At 18 months, the intervention group reported significantly more consistent condom use with trends toward more consistent hormonal and dual method use. Dose-response analyses suggested that relatively high levels of exposure to a youth development intervention were needed to change contraceptive use behaviors among adolescents at risk for early pregnancy. Given promising findings, further testing of the Prime Time intervention is warranted.

Protective factors in the lives of bisexual adolescents in North America.

OBJECTIVES: We compared protective factors among bisexual adolescents with those of heterosexual, mostly heterosexual, and gay or lesbian adolescents. METHODS: We analyzed 6 school-based surveys in Minnesota and British Columbia. Sexual orientation was measured by gender of sexual partners, attraction, or self-labeling. Protective factors included family connectedness, school connectedness, and religious involvement. General linear models, conducted separately by gender and adjusted for age, tested differences between orientation groups. RESULTS: Bisexual adolescents reported significantly less family and school connectedness than did heterosexual and mostly heterosexual adolescents and higher or similar levels of religious involvement. In surveys that measured orientation by self-labeling or attraction, levels of protective factors were generally higher among bisexual than among gay and lesbian respondents. Adolescents with sexual partners of both genders reported levels of protective factors lower than or similar to those of adolescents with same-gender partners. CONCLUSIONS: Bisexual adolescents had lower levels of most protective factors than did heterosexual adolescents, which may help explain their higher prevalence of risky behavior. Social connectedness should be monitored by including questions about protective factors in youth health surveys.

Protecting urban American Indian young people from suicide.

OBJECTIVE: To examine the likelihood of a past suicide attempt for urban American Indian boys and girls, given salient risk and protective factors. METHODS: Survey data from 569 urban American Indian, ages 9-15, in-school youths. Logistic regression determined probabilities of past suicide attempts. RESULTS: For girls, suicidal histories were associated with substance use (risk) and positive mood (protective); probabilities ranged from 6.0% to 57.0%. For boys, probabilities for models with violence perpetration (risk), parent prosocial behavior norms (protective), and positive mood (protective) ranged from 1.0% to 38.0%. CONCLUSIONS: Highlights the value of assessing both risk and protective factors for suicidal vulnerability and prioritizing prevention strategies.

Associations between health screening questions and sexual risk behaviors in adolescent female clinic patients: identifying a brief question format to yield critical information.

This study examines the ability of brief screening questions to identify adolescent girls at high risk for sexually transmitted infections and teen pregnancy. Participants included 103 sexually active 13-year-old to 17-year-old girls recruited from adolescent clinics who (1) were identified as at risk for negative sexual health outcomes through responses to an 8-item Health Screening Survey, and (2) returned to clinic within 2 weeks to complete a self-report survey about sexual risk behaviors and contraceptive use. Analyses examined relationships between girls' total screening scores, individual screening survey items, and 5 self-reported sexual risk behaviors. Higher screening scores correlated with lower levels of refusing unprotected sex and less consistent condom use (P < .05 and P < .01, respectively). High-risk responses to 2 screening items were associated with all 5 sexual risk behaviors. Findings suggest useful questions in routine clinical screening of sexually active adolescent girls to identify those at high levels of sexual risk.

Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British Columbia.

Over the past decade, several large-scale school-based studies of adolescents in Canada and the U.S. have documented health disparities for lesbian, gay and bisexual teens compared to their heterosexual peers, such as higher rates of suicide attempts, homelessness, and substance use. Many of these disparities have been linked to "enacted stigma," or the higher rates of harassment, discrimination, and sexual or physical violence that sexual minority youth experience at home, at school, and in the community. An unexpected health disparity for lesbia n, gay and bisexual youth is their significantly higher risk of teen pregnancy involvement (between two and seven times the rate of their heterosexual peers), especially in light of declining trends in teen pregnancy across North America since the early 1990s. What is behind this higher risk? Is it getting better or worse? Using the province-wide cluster-stratified British Columbia Adolescent Health Surveys from 1992, 1998, and 2003, this paper explores the trends in pregnancy involvement, related sexual behaviours, and exposure to forms of enacted stigma that may help explain this particular health disparity for gay, lesbian and bisexual youth in Canada.

Friends' influence on adolescents' first sexual intercourse.

CONTEXT: Social-psychological theories of health behavior suggest that adolescents' sexual behaviors are influenced by the sexual attitudes and behaviors of their friends. METHODS: Data on 2,436 participants in the National Longitudinal Study of Adolescent Health (Add Health) who were sexually inexperienced at Wave 1 (1994-1995) were analyzed to examine whether friend-related variables predicted initiation of vaginal intercourse by Wave 2 (1996). Analyses also assessed whether predictive relationships varied by level of involvement with friends. Odds ratios were generated by logistic regression analysis. RESULTS: In the 9-18 months between Waves 1 and 2, 18% of participants initiated intercourse. In analyses controlling for gender, family structure and romantic relationships, the higher the proportion of a youth's friends who were sexually experienced, the greater the odds of sexual debut (odds ratio, 1.01); the odds also were elevated among youth who believed that they would gain their friends' respect by having sex (1.2). Relationships between friend variables and sexual initiation did not vary by level of involvement with friends. CONCLUSIONS: To maximize the likelihood of success, programs focused on delaying teenage sexual intercourse should address norms for sexual behavior among adolescents' close friends as well as the perceptions, skills and behaviors of individual youth.

Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada.

Some studies suggest lesbian, gay, and bisexual (LGB) teens are at higher risk than peers for violence at home, in school, and in the community. That can bring them into the child welfare system or services for runaway and homeless teens. This study compared self-reported experiences of sexual and physical abuse based on sexual orientation and gender in seven population-based surveys of youth. The authors used c2 and age-adjusted odds of abuse to compare bisexual to heterosexual, mostly heterosexual, and gay and lesbian students. They also provide case studies to illustrate the experiences of such youth.

Violence perpetration among urban american Indian youth: can protection offset risk?

OBJECTIVE: To predict the likelihood of violence perpetration given various combinations of the most statistically salient risk and protective factors related to violence perpetration. DESIGN: Urban Indian Youth Health Survey, conducted from October 9, 1995, to March 30, 1998, consisting of 200 forced-choice items exploring values, cultural identity, relationships, decision-making skills, and health and well-being. SETTING: Urban schools and an after-school youth development program at an urban American Indian center. PARTICIPANTS: Five hundred sixty-nine urban American Indian youth enrolled in grades 3 through 12. MAIN OUTCOME MEASURES: Violence perpetration dichotomized in 2 ways: (1) level of violence perpetration (ie, hitting someone 1-2 times in the past year vs picking fights, hitting repeatedly, participating in group fights, or shooting or stabbing someone in the past year) and (2) having shot and/or stabbed someone during the past year. RESULTS: In the final multivariate models with age as a covariate, most protective against violence perpetration were connections to school (odds ratio [OR], 0.17), positive affect (OR, 0.29), and peer prosocial behavior norms against violence (OR, 0.35). School connectedness (OR, 0.01) and positive affect (OR, 0.46) were also protective against shooting and/or stabbing someone, as was parental prosocial behavior norms against violence (OR, 0.23). The strongest risk factors for violence perpetration were substance use (OR, 2.60) and suicidal thoughts/behaviors (OR, 2.71); for shooting and/or stabbing, it was substance use (OR, 5.26). The likelihood of violence perpetration increased markedly (from 10% to 85%) as the exposure to risk factors increased and protective factors decreased. For shooting or stabbing someone, the probabilities ranged from 3% (0 risks and 3 protective factors) to 64% (1 risk and 0 protective factors). CONCLUSION: The dramatic reduction in the likelihood of violence involvement when risk was offset with protective factors in the probability profiles suggests the utility of a dual strategy of reducing risk while boosting protection.

Early death perception in adolescence: identifying factors associated with change from pessimism to optimism about life expectancy.

US teens overestimate risk for early death. The purpose of this study was to identify factors associated with an adolescent's change from early death perception to a belief in living into adulthood. Data are from 9140 adolescents participating in waves 1 (1995) and 2 (1996) of the National Longitudinal Study of Adolescent Health. Logistic regression models were used to determine contexts of healthy and unhealthy change associated with the likelihood of early death perception change. Youth report of increased caring and connection to other adults and increased self-esteem were associated with greater likelihood of moving from pessimism to optimism about life expectancy (P = .003 and P = .038, respectively). Reductions in self-esteem and poorer perception of health were associated with decreased odds of death perception change (P = .017 and P = .011, respectively). Nurturing positive connections with adults and strategies that improve a youth's self-esteem offer 2 opportunities to facilitate adolescent early death perception change.

Adolescent early death perception: links to behavioral and life outcomes in young adulthood.

INTRODUCTION: The purpose of this study was to examine the relationship between changes in adolescent perception of risk for early death over time and behavioral and life outcomes in young adulthood. METHODS: This is a secondary data analysis of 7202 respondents participating in waves 1 (1995), 2 (1996), and 3 (2001-2002) of the in-home interviews from the National Longitudinal Study of Adolescent Health. Linear and logistic regression models were used to determine the predictive ability of adolescent early death perception at waves 1 and 2 on young adult outcomes of health risk, human capital, and prosocial development, and fitness at wave 3. RESULTS: Nearly one in four youth (23%) expressed perceived risk of premature death at some point in time; 6% of youth persisted in this outlook. Perceived risk of premature death during adolescence was linked to poor health and productivity on multiple levels in young adulthood. DISCUSSION: Adolescent perceived risk for premature death portends poor outcomes in young adulthood. Findings support incorporating screening questions on adolescents' mortality beliefs into psychosocial assessments and interviews.

Individual, interpersonal, and relationship factors predicting hormonal and condom use consistency among adolescent girls.

INTRODUCTION: Few existing studies have considered influences of adolescents' sexual partners on contraceptive consistency. This study examines the influence of personal characteristics, partner characteristics, and relationship factors on consistency of contraceptive use among an ethnically diverse sample of adolescent girls at high risk for pregnancy and sexually transmitted diseases. METHOD: Data are from 110 sexually active 13- to 17-year-old girls participating in a clinic-based intervention study aimed at reducing sexual risk behaviors. Personal characteristics were assessed at baseline (T1), and partner and relationship characteristics were assessed at 12 months (T2). RESULTS: Multivariate analyses revealed that T2 hormonal contraceptive consistency was predicted by T1 hormonal consistency, girls' desire to use birth control, having the same sexual partner at T1 and T2, perceived partner support for birth control, and communication with partner about sexual risk. T2 condom use consistency was negatively predicted by emergency contraceptive use history and perceived partner support for birth control. DISCUSSION: Findings underscore the importance of nurses addressing both personal and relationship factors in their efforts to promote consistent contraceptive use among sexually active adolescent girls.

From adolescent connections to social capital: predictors of civic engagement in young adulthood.

PURPOSE: This study examined the ability of adolescent connection in family and community contexts to promote an aspect of healthy youth development and transition into adulthood, civic engagement. METHODS: Data are from Wave 1 (1995) and Wave 3 (2001-2002) of the in-home interviews from the National Longitudinal Study of Adolescent Health. The sample for this study included 9130 young adults aged 18-26 years. Linear and logistic regression models were used to measure the influence of connection in family and community contexts (Wave 1) on outcomes of civic engagement in young adulthood (Wave 3). RESULTS: Stronger connection in all family and community contexts during adolescence predicted greater likelihood of voting, community volunteer service, involvement in social action/solidarity groups, education groups, and/or conservation groups, and endorsement of civic trust in young adulthood. Select connections in family and community contexts were also significant predictors of political voice/involvement and blood product donation. In a final multivariate model, frequency of shared activities with parent(s) and school connection during adolescence emerged as unique predictors of young adult civic engagement. CONCLUSIONS: Connections in family and community contexts during adolescence promote healthy youth development through facilitation of multiple aspects of civic engagement in young adulthood. The importance of these connections in fostering youth capacity to bond to a broader community construct is discussed.

Adolescent perception of premature risk for death: contributions from individual and environmental contextual factors.

OBJECTIVE: Adolescent perception of premature risk for death is a cause of great concern. This study identified individual and environmental characteristics of youth expressing perception of premature risk for death. METHODS: Data are from Waves 1 (1995) and 3 (2001-2002) of the in-home interviews from the National Longitudinal Study of Adolescent Health. The study sample included 12,103 adolescents and 10,519 parents (Wave 1) and 9130 young adults (Wave 3). Logistic regression models were used to determine contexts for health risk, connection, safety and monitoring, individual/developmental, and caregiver/family characteristics associated with adolescent early death perception. RESULTS: One in 7 youth endorsed perceived risk for early demise. After controlling for demographic factors, adolescent early death perception is a powerful marker for high-risk status, including involvement in self-destructive behaviors (odds ratio [OR] 1.32-13.97, P = .01-P <.001) and physical and psychological distress (OR 8.33-39.37, P < .001). Alternately, models for stronger connection in the primary socializing domains, perceptions of safety, academic achievement, outlets for participation, and better caregiver capacity offered significant protective effect (OR 0.10-0.91, P < .001). In a final multivariate model, unique relationships between adolescent early death perception and health risk behavior and exposure, adult and peer connection, mental health, and parent/family economic security emerged. CONCLUSIONS: Study findings support further research into constructs for premature death perception as a potential mechanism to facilitate intervention with youth who may be at risk for further negative life trajectories, including depressive reactions and extreme reactions to future adverse life events.

Is school-based height and weight screening of elementary students private and reliable?

The Institute of Medicine recommends school-based body mass index (BMI) screening as an obesity prevention strategy. While school nurses have provided height/weight screening for years, little has been published describing measurement reliability or process. This study evaluated the reliability of height/weight measures collected by school nurses and the privacy of the measurement process. Interrater reliability for height/weight measures was computed on 70 elementary students, comparing measurements collected by a trained researcher to those collected by 7 school nurses. Students arrived in small groups to private measurement spaces. Height agreement was 80% for younger and 85% for older students. Agreement for weight was 97% and 100%, respectively. Reliability for weight was very good. Reliability for height was good, but results suggest careful attention to the collection process is required. Nurses may benefit from regular training on measurement procedures. The results of this study suggest that school nurses provide BMI screening that is private and reliable.

Family and racial factors associated with suicide and emotional distress among latino students.

BACKGROUND: Latino youth experience disproportionate rates of mental health problems including suicide and depression. Better understanding of underlying risk and protective factors on the part of school-based health professionals, teachers, and health care providers in their lives is warranted. The aims of this secondary analysis of 2004 Minnesota Student Survey data were to (1) describe the mental health status of a statewide sample of Latino 9th- and 12th-grade students; (2) explore relationships of family protective factors (communication, caring, and connection) with suicidal ideation, suicidal attempts, and emotional distress; and (3) highlight similarities and differences in family protective factors among subgroups of Latino students. METHODS: Parallel analyses were completed for Latino-only and Latino-mixed students. Bivariate logistic regression models were used to examine associations between each family variable and each study outcome. RESULTS: Nearly 1 in 5 Latino high school students have had suicidal thoughts in the past year; past year suicide attempts ranged from 6% to 18.5% across grade and gender subgroups. Most concerning are ninth-grade Latino girls, a group in which 30-40% reported suicidal thoughts and 14-19% reported attempting suicide in the past year. CONCLUSIONS: An important study finding is the high rate of suicidal ideation, suicide attempts, and emotional distress among students who self-identified as being of mixed ethnicity. Study findings can be used to inform mental health promotion initiatives and culturally tailor interventions with Latino students.

Adolescent dual method use: relevant attitudes, normative beliefs and self-efficacy.

PURPOSE: To encourage dual contraceptive method use--protection from both STD and pregnancy--health behavior change efforts must target powerful risk and protective factors that are amenable to change. This study examines longitudinal relationships between adolescents' contraceptive-related cognitions and dual method use. METHODS: Data are from 1123 sexually active 7-11th-grade participants in the National Longitudinal Study of Adolescent Health, Waves 1 and 2 (W1, W2). A series of nested path models examined relationships between participants' contraceptive use level at most recent intercourse (zero, one, two methods) and contraceptive-related cognitions. Parallel analyses were completed with four grade/gender groups. RESULTS: Dual method use at most recent intercourse ranged from 14.3% to 25.0%. Path models suggested that contraceptive use levels and contraceptive-related cognitions were moderately stable over time. Cross-sectionally, contraceptive use level was associated with parent approval of birth control (older youth, younger girls), birth control attitudes (older youth, younger boys), perceived pregnancy consequences (older youth), perceived sexually transmitted disease risk (older girls), perceived benefits of sex (younger girls), and contraceptive self-efficacy (older youth). W1 father approval of birth control (younger girls), mother disapproval of sex (older girls), and birth control attitudes (older boys) predicted W2 contraceptive use levels. W1 contraceptive use levels predicted several W2 cognitions among older youth. CONCLUSIONS: Sexually active adolescents' perceptions of parent expectations about sex and contraception have important links to dual method use. Adolescents' attitudes about practical, social, and moral implications of using birth control are also linked to their use of dual contraceptive methods.

Suicidal ideation and attempts in North American school-based surveys: are bisexual youth at increasing risk?

This study explored the prevalence, disparity, and cohort trends in suicidality among bisexual teens vs. heterosexual and gay/lesbian peers in 9 population-based high school surveys in Canada and the U.S. Multivariate logistic regressions were used to calculate age-adjusted odds ratios separately by gender; 95% confidence intervals tested cohort trends where surveys were repeated over multiple years. Results showed remarkable consistency: bisexual youth reported higher odds of recent suicidal ideation and attempts vs. heterosexual peers, with increasing odds in most surveys over the past decade. Results compared to gay and lesbian peers were mixed, with varying gender differences in prevalence and disparity trends in the different regions.

Sexual orientation, sexual abuse, and HIV-risk behaviors among adolescents in the Pacific Northwest.

OBJECTIVES: We explored HIV risk behaviors, sexual orientation, and sexual abuse among 5 school-based cohorts in Seattle, Wash (SEA95 and SEA99:N=7477 and N=6590), and British Columbia (BC92, BC98, and BC03 [weighted]: N=239975, N=281576, and N=265132). METHODS: An HIV risk scale of 7 items assessed risky sexual behaviors and injection drug use. Self-identified sexual orientation included heterosexual, bisexual, gay/lesbian, and, in British Columbia only, mostly heterosexual. Analyses of covariance were conducted separately by gender and were adjusted for age and sexual abuse when comparing means. RESULTS: Gay/lesbian and bisexual adolescents had higher mean age-adjusted risk scores compared with heterosexual and mostly heterosexual adolescents. After we controlled for sexual abuse history, mean scores were 2 to 4 times higher among abused students than among nonabused students in each sexual orientation group. Age/abuse-adjusted models better explained the variance in risk scores (R(2)=0.10-0.31), but sexual orientation remained an independent predictor. CONCLUSION: Sexual minority adolescents who attended school reported higher HIV risk behaviors, and higher prevalence of sexual victimization may partially explain these risks.