Attachment and sexual health behaviors in homeless youth.

PURPOSE: To explore relationships and group differences in attachment-related constructs (social connectedness and social support) and sexual health behaviors in a sample of homeless youth. DESIGN AND METHODS: An exploratory design, this study analyzed baseline data from an ongoing intervention study. Survey data were collected by audio, computer-assisted self-interview (A-CASI) from a nonprobability sample of homeless youth (n = 176). RESULTS: Social connectedness was positively correlated with period of time homeless, while social support was positively related to sexual self-concept and to self-efficacy and intention to use condoms. PRACTICE IMPLICATIONS: The street group that homeless youth identify with may be a potential resource for peer-mentoring and skill-building regarding healthy sexual behavior.

Health promotion for women with human immunodeficiency virus or acquired immunodeficiency syndrome.

PURPOSE: The purpose of this pilot study was twofold: first, to modify Stuifbergen's health promotion intervention initially developed for women with multiple sclerosis for use among women with human immunodeficiency virus or acquired immunodeficiency syndrome (HIV/AIDS) and to evaluate the feasibility of the newly modified health promotion intervention named "Put Health Into Living" (PHIL). The pilot study was completed in two phases. DATA SOURCES: In phase I, data were derived from a literature review, a focus group of women with HIV/AIDS (n= 7), a panel of experts who reviewed the intervention for content, and three female community workers who evaluated the intervention for the context of living with HIV/AIDS, cultural relevancy, and literacy. During phase II, a pretest/posttest one-group design was used to determine the feasibility of the study methods, content, and format of the health promotion intervention among 10 women with HIV/AIDS. CONCLUSIONS: The pilot study demonstrated the importance of a health promotion intervention for a vulnerable population. Participants verbalized the benefits of attending a health promotion program to gain knowledge and skills to promote their health. One woman said, "I have been positive for 20 years now and no one has talked to me just about my overall health." Participants indicated the PHIL intervention offered a supportive group environment, an overall health focus, and an acceptable format. IMPLICATIONS FOR PRACTICE: Health promotion is a desirable goal for persons living with a chronic disease, and the PHIL intervention has the potential to benefit persons living with HIV/AIDS if subsequent evidence is found in further testing of the intervention.

Factors that influence adherence to HIV medications: perceptions of women and health care providers.

The purpose of this pilot study was to explore factors that influence adherence to antiretroviral therapy (ART) in women with human immunodeficiency virus (HIV) disease. Antiretroviral medications that reduce viral count and prolong the time between a diagnosis of HIV disease and acquired immunodeficiency syndrome (AIDS) are expensive, numerous, and have multiple side effects. Common reasons for not adhering to the medication regimen include ART side effects and a dosage schedule that disrupts daily activities. Failure to take or errors in taking ART can result in an exacerbation of symptoms and disease progression or the development of drug-resistant strains of HIV. Women and providers in separate focus groups identified factors that facilitated and hindered adherence to ART. Knowledge of factors that influence adherence to ART will facilitate the development of interventions. Patient-provider relationships and side effects of weight gain are discussed as factors that influence adherence to ART.

Reliability and validity of motivation for sexual health.

The Health Self-Determinism Index-Sexual (HSDI-S) is a modification of the HSDI (a measure of motivation of health). Psychometric evaluation was needed to determine the usefulness of the HSDI-S as a measure of motivation of sexual health. The purpose of this study was to assess the reliability and validity of the HSDI-S. Three unique samples of HSDI-S scores were evaluated using principal component and maximum likelihood factor analyses with a Varimax rotation. Items that loaded on each of the factors were similar across all three samples. Factor analyses revealed two dimensions of the HSDI-S: self-directed and partner-directed motivation, which is discussed within the context of relationships. The ranges of internal consistency reliability coefficients across the samples were satisfactory for the HSDI-S (.74-.82) and for the two dimensions (.66-.77). Reliability and construct validity of the HSDI-S across three diverse samples was supported.

Developing an economic IQ in primary care.

PURPOSE: To describe elements of an economic intelligence quotient (IQ) that can be used to enhance the nurse practitioner's (NP) fiscal viability in a primary care setting. DATA SOURCES: Anecdotal data from providers and administrators; clinical experiences of the authors; scientific and government publications and guidelines. CONCLUSIONS: In the United States, managed care cost-containment initiatives have led to competition among physicians and NPs for patients and jobs. An understanding of the economic base of a practice is essential to fiscal viability in this market. PRACTICE IMPLICATIONS: When turf and job competition are the norm, it is essential that the NP develop an economic IQ. Knowledge of coding, billing, reimbursement, and documentation are critical to identifying the NP's value to the practice and promoting job retention. The challenge is for the NP to give high-quality, cost-effective, and safe patient care and to be a productive provider.

Integrating evidence-based practice in nurse practitioner education.

This column normally focuses on a specific clinical practice guideline (CPG). This month's column deviates from that practice to demonstrate how evidence-based practice (EBP) was integrated into the nurse practitioner (NP) curriculum at the University of Texas at Austin School of Nursing. Processes of EBP were linked to student clinical assignments across core NP clinical courses, culminating in a student-published CPG. When students research and analyze available scientific evidence for a CPG, they learn to critically evaluate and logically organize knowledge for use in clinical practice, and those critical-thinking skills can lead to improved clinical reasoning and decision making.

The impact of genetic information on policy and clinical practice.

This article discusses genetics-related policy issues that have an impact on health care systems, health care providers, and their patients: privacy, mass screening, family screening, and knowledge dissemination. Access, cost, and ethical implications are important discussant points for each of these genetic-related policy issues. Embedded in the issue of privacy are concerns of insurability, confidentiality, and discrimination. The public health policy implications related to mass screening programs include efficacy of the screening tests, availability of primary and secondary interventions, access, costs, and program evaluation. Policy issues for family screening are similar to mass screening, with added concerns about privacy and availability of adequate resources, including health care providers and counselors trained in genetics. Knowledge dissemination is critical to maintaining currency of clinical information and applications of genetic technologies and treatments. As genetic information expands, the need for knowledge dissemination will increase. The importance of advanced practice nurses' involvement in these policy issues is discussed.

Factors that influence vulnerability to STDs and HIV/AIDS among Hispanic women.

Self-esteem, motivation for sexual health, and sexual risk behaviors as indicated by condom use and number of sex partners was explored in a sample of 140 Hispanic women of childbearing age (18-44 years). The researchers used Cox's Interaction Model of Client Health Behavior (IMCHB) as the conceptual framework for the study. They found that 70% (n = 79) of single women reported condom use with their most recent sexual partner, and 49% (n = 55) of single women reported more than one sexual partner in the last 12 months. Self-esteem and motivation for sexual health were significantly associated (r =.42, p =.001), although only the latter was related to condom use among single women (r =.29, p =.01). Women who reported higher self-esteem were less likely to worry about acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Despite public information about STDs, including HIV/AIDS, a proportion of these women and their partners are vulnerable to these diseases. Health promotion implications are discussed.

Cognitive reorganization and stigmatization among persons with HIV.

BACKGROUND: A diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a life-changing event, where persons must deal with a life-threatening, debilitating disease and its associated stigma and isolation. Studies over the past decade have shown that writing and talking about stressful and traumatic experiences, such as a life-threatening illness, causes emotions surrounding the trauma to change and to become cognitively reorganized. The result is a reduction in inhibition and change in basic cognitive and linguistic processes, which have contributed to meaningful behavioural, psychological, and physical health benefits across a variety of populations. AIMS: To describe the construction of the Integrated Model of Health Promotion for persons with HIV/AIDS, and present initial empirical support of the model from a feasibility pilot study of women with HIV/AIDS. APPROACH: The Integrated Model of Health Promotion is described and relevant literature in the field is reviewed. The model is implemented in a feasibility pilot study utilizing the emotional writing disclosure intervention. RESULTS: Participants in the experimental condition demonstrated a promising pattern of cognitive reorganization, a reduced perception of stigma, and an improvement in mental health scores compared with the control condition. CONCLUSION: Implications of these findings are discussed within the framework of the Integrated Model of Health Promotion. The model explores health and behavioural benefits associated with emotional writing in individuals with HIV/AIDS. The limited sample size of this pilot study precludes testing for significance. Further studies are required prior to the development of practice guidelines.

Dermatitis de contacto con irritantes y alergenos / Irritant and allergic contact dermatitis

La dermatitis de contacto es uno de los problemas cutaneos que mas a menudo se presentan no solo en la practica dermatologica sino tambien en la consulta medica general. Para poder establecer un tratamiento eficaz, es indispensable eliminar el irritante o el alergeno del entorno de la persona afectada