Prevalence and predictors of sexual dysfunction in long-term survivors of marrow transplantation.

PURPOSE: To describe the prevalence of sexual difficulties in men and women after marrow transplantation (MT), and to define medical, demographic, sexual, and psychologic predictors of sexual dysfunction 3 years after MT. PATIENTS AND METHODS: Four hundred seven adult MT patients were assessed pretransplantation. Survivors repeated measures of psychologic and sexual functioning at 1 and 3 years posttransplantation. RESULTS: Data were analyzed from 102 event-free 3-year survivors who defined themselves as sexually active. Men and women did not differ in sexual satisfaction pretransplantation. At 1 and 3 years posttransplantation, women reported significantly more sexual dysfunction than men. Eighty percent of women and 29% of men reported at least one sexual problem by 3 years after MT. No pretransplantation variables were significant predictors of 3-year sexual satisfaction for women. For men, pretransplantation variables of older age, poorer psychologic function, not being married, and lower sexual satisfaction predicted sexual dissatisfaction at 3 years (R2=.28; P < .001). Women who were more dissatisfied 3 years after MT did not receive hormone replacement therapy (HRT) at 1 -year posttransplantation and were less satisfied at 1 year, but not pretransplantation (R2=.35; P < .001). CONCLUSION: Sexual problems are significant in the lives of MT survivors, particularly for women. Although HRT before 1 year posttransplantation improves sexual function, it does not ensure sexual quality of life. Intervention for women is needed to apply hormonal, mechanical, and behavioral methods to prevent sexual difficulties as early after transplantation as possible.

Paternal and maternal genetic and environmental contributions to cerebrospinal fluid monoamine metabolites in rhesus monkeys (Macaca mulatta).

BACKGROUND: To study genetic and environmental contributions to cerebrospinal fluid (CSF) monoamine concentrations, 55 young rhesus monkeys (Macaca mulatta) were reared apart from their 10 fathers to perform a paternal half-sibling analysis. METHODS: To study maternal genetic contributions, 23 infants were reared with their mothers, 23 infants were removed from their mothers at birth and fostered to unrelated lactating female monkeys, and 24 infants were removed from their mothers at birth and reared with age-matched peers. When the monkeys reached age 6 months, CSF samples were obtained via cisternal puncture prior to and during a series of social separations. RESULTS: When the results were statistically pooled according to the biological father, comparisons using analysis of variance indicated that both CSF 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) concentrations showed significant heritable (h2) effects (h2 > 0.5) for both sons and daughters, whereas 3-methoxy-4-hydroxyphenylglycol (MHPG) showed a nearly significant paternal genetic effect only for sons (h2 > 0.5). In addition, there were substantial maternal genetic influences on the young monkeys' CSF MHPG and 5-HIAA (h2 > 0.5) levels. Structural equation analyses indicated a maternal genetic contribution without a maternal environmental contribution to CSF 5-HIAA concentration; on the other hand, there was both a maternal genetic and environmental contribution to MHPG. CONCLUSIONS: These findings suggest that a significant portion of the variance in the turnover of the monoamine neurotransmitters is determined by genetic mechanisms.

Lithium carbonate in the treatment of tardive dyskinesia.

Six patients with tardive dyskinesia were treated with lithium carbonate in an open clinical trial. Evaluations using a new tardive dyskinesia rating scale showed statistically significant improvement in dyskinetic movements while the patients received lithium. This improvement was consistently observed in all patients but was relatively small when compared to the amount of pathology present.

Natural killer cell activity is reduced in association with oral contraceptive use.

Oral contraceptive (OC) use has been associated with increased incidence of a number of infections, but the mechanisms behind these changes is unclear. The present study compared OC users and nonusers in natural killer (NK) cell activity, NK phenotype, and illness frequency. Subjects were 55 female medical students (19 OC users, 36 nonusers). Three blood samples were obtained, 1 mo apart. Natural cytotoxicity was tested with a 51Cr assay. Self reports of illness symptoms during the previous week were collected at each blood sampling. NK phenotype number was assessed by flow cytometry. Oral contraceptive users had lower natural cytotoxicity and increased frequency of sneezing, gastrointestinal distress, runny nose, sore throat, coughing, and total illness symptoms, relative to nonusers. No differences were found between OC users and nonusers in NK phenotype number. These findings support the hypothesis that differences between users and nonusers in infection rates might be due to alterations in NK activity.

PIP: Oral contraceptive (OC) use has been associated with increased incidence of a number of infections, but the mechanisms behind such changes are unclear. Comparison of lymphocyte phenotypes between contraceptive users and nonusers found no difference in either the percentage or absolute numbers of any cell types. Other data, however, suggest differences in natural cytotoxic activity in contraceptive users. Natural cytotoxic activity in normal women has been found to vary with menstrual phase and estradiol levels, being lowest mid-cycle, shortly following peak estradiol levels. OC users, however, demonstrate no variation in either natural killer (NK) cell activity or estradiol levels over their cycles. The authors report their findings from a study comparing 19 OC users and 36 nonusers in NK cell activity, NK phenotype, and illness frequency. Three blood samples were obtained one month apart from each of the female medical student participants. Natural cytotoxicity was tested with a Cr assay, while NK phenotype number was assessed by flow cytometry. Relative to nonusers, OC users had lower natural cytotoxicity and increased frequency of sneezing, gastrointestinal distress, runny nose, sore throat, coughing, and total illness symptoms. No differences were found between OC users and nonusers in NK phenotype number. These findings support the hypothesis that differences between users and nonusers in infection rates may be due to alterations in NK activity.

Thyroid hormones: positive relationships with cognition in healthy, euthyroid older men.

BACKGROUND: Although the association of clinical hypothyroidism with cognitive deficits is well known, the cognitive effects of thyroid hormones in euthyroid subjects are less studied and understood. The purpose of this study was to examine thyroid-cognition relationships in healthy, euthyroid older men. METHODS: We examined healthy men (N = 44, mean age = 72), excluding clinically hypothyroid/hyperthyroid or diabetic/hyperglycemic subjects and those with dementia, depression, CNS medications, or recent illness. Plasma samples obtained across a 24-hour period were pooled, then assayed for total thyroxine (TT4), total triiodothyronine (TT3), and T3 resin uptake. Free thyroxine index (FT4I) was calculated. A broad cognitive battery (including the Wechsler Adult Intelligence Scale-Revised [WAIS-R], the Dementia Rating Scale [DRS], and the Rivermead Behavioral Profile [PROFILE]) was administered to all subjects. RESULTS: Regression analyses controlling age and education showed TT4 and FT4I to have significant positive relationships with measures of overall cognition; TT4 accounted for 8% to 12% of the variance in omnibus cognitive measures such as WAIS Performance, WAIS Verbal score, and GLOBAL cognitive scores. CONCLUSIONS: Our findings suggest that within "normal" range of variation in plasma thyroid hormones, TT4 but not T3 positively associates with general cognition in healthy elderly men.

Coronary heart disease moderates the relationship of chronic stress with the metabolic syndrome.

Metabolic syndrome levels (MSLs) were compared in caregivers (CGs) of spouses with Alzheimer's disease who had diagnoses of coronary heart disease (CHD; n = 27) with non CGs with CHD diagnoses (n = 18), and CGs (n = 44) to non CGs (n = 52) free of CHD. MSLs were greater for CGs than non CGs, but only in persons with CHD (CHD, B for CG status = -.41; non CHD, B = .12; p < .05) at study entry (Time 1 = T1) and CHD, B = -.32; non CHD, B = .14; p < .05) 15-18 months later (Time 2 = T2). In the CHD group, MSLs were associated with poorer health habits at T1 (r = .39, p < .01), uplifts (r = -.37, p < .01) at T2, and CG status (p < .05) at T1 and T2. Relationships of CG status and MSLs declined in the presence of poor health habits at T1 and uplifts at T2. Poorer health habits and fewer uplifts may be associated with elevated MSLs in CGs with CHD.

Are the salutogenic effects of social supports modified by income? A test of an "added value hypothesis".

Older adults (54 men, 113 women; M age = 69.5 years) were examined to test the hypothesis that social supports would be more salutogenic (health promoting) for persons with lower incomes than for persons with higher incomes. Interactions of income and social supports (mean of 3 emotional scales of the Interpersonal Support Evaluation List) at study entry predicted changes 15-18 months later in a cardiovascular composite (linear combination of high-density lipoproteins-mean arterial pressure; p < .05), and natural killer cell activity (p < .05). For both outcomes, emotional supports were salutogenic for persons with lower incomes (< or =$29,000/year), but not for persons with higher incomes (>$29,000/year). In contrast, interactions of the Tangible Support Scale with income did not occur. Persons with lower incomes may derive benefits from social supports that go beyond tangible assistance.

Juvenile friends, behavior, and immune responses to separation in bonnet macaque infants.

Individual differences in the response to maternal separation in nonhuman primate infants have been attributed to (among other variables) presence or absence of processes that may model social support in humans. Alternative attachments to other members of the social group buffer the infant against a depressive response to maternal separation. This hypothesis was tested in a group of bonnet macaques by manipulating the presence or absence of alternative juvenile attachment figures (friends) during separation. Infants who retained such attachments showed fewer behavioral evidences of depression when separated from their mothers. These infants without friends also showed changes in lymphocyte activation by mitogens or natural cytotoxicity that were not evident in the infants with juvenile friends. Across all separated infants, natural cytotoxicity was positively correlated with juvenile affiliative behavior directed toward the infants during the separation. These results support the hypothesis that social support, available from alternative attachments, can modulate the response to loss, and can account for some of the individual differences seen in these responses.

Weight changes in caregivers of Alzheimer's care recipients: psychobehavioral predictors.

Relationships of changes in body mass index (BMI) were examined with changes in psychobehavioral variables in spouse caregivers of individuals with Alzheimer's disease (n = 81) and matched spouses of controls (n = 86). Men caregivers had significantly greater BMI and obesity than men controls at both times. Over 15-18 months, women caregivers gained significantly more weight than did women controls. A trend for greater obesity occurred in women caregivers than in women controls at follow-up. Although weight gain was not related to psychobehavioral variables in controls, in men caregivers decreased perceived control and increased fat intake explained significant variance in weight gain. In women caregivers, increased anger control and increased calories explained weight gain. Such caregivers may be at risk for health problems.

Identifying the sexually abused deaf child: the otolaryngologist's role.

As a primary physician for most deaf children, the otolaryngologist must be able to identify signs and symptoms of sexual abuse. Child sexual abuse is a topic of national concern as epidemiologic data indicate more than 100,000 American children become victims annually. This paper provides an overview of the incidence, demographic characteristics, risk factors, and dynamics of child sexual abuse within both the general handicapped and, specifically, the hearing imparied populations. Strategies for identifying the sexually abused hearing impaired child are delineated including the physical appearance and behavioral manifestations of child victims, as well as the characteristics of abusive caretakers and perpetrators. Case summaries are presented which illustrate these characteristics. A national center specializing in the evaluation and treatment of abused handicapped children is described.

Psychological distress, caregiving, and metabolic variables.

This study examined relationships between chronic stress and insulin/glucose in two groups of nondiabetics, M age = 69.4: spouse caregivers (CGs) of persons with Alzheimer's disease (n = 73) and age- and gender-matched spouses of nondemented controls (COs) (n = 69). Fasting insulin/glucose and psychological variables were assessed twice (Time 1, Time 2) over a 15-18 month period. CGs had significantly higher insulin levels at Times 1 and 2 than did COs even when obesity, exercise, gender, age, alcoholic drinks, hormone replacement therapy (HRT), lipids, and hypertension (HTN) were considered in the analyses. CGs generally reported significantly more psychological distress (higher burden, depression, hassles, and lower uplifts) than did COs at each time. Differences in psychological distress at Time 1 between CGs and COs did not mediate the insulin difference in the groups at Time 1, but differences in distress at Time 2 between CGs and COs did mediate their difference in insulin at Time 2. Although caregiver status was not associated with glucose at Time 1 or Time 2, psychological distress was positively associated with glucose at Time 2. Moreover, psychological distress at Time 1 was associated with higher glucose at Time 2 after controlling for glucose at Time 1. These data suggest that relationships between psychological and physiological distress exist both cross-sectionally and over time. These results may be important because higher insulin and glucose levels are associated with increased coronary risk and coronary heart disease.

Patterns of physical and sexual abuse of communicatively handicapped children.

Evidence suggests that handicapped children are at increased risk for abuse and neglect. Communicatively impaired youngsters are particularly vulnerable because of their limited ability to report the maltreatment. Of 482 abused handicapped children evaluated at Boys Town National Research Hospital, 212 had hearing impairment, 87 speech language disorders, 39 learning disorders, 43 behavioral-emotional disturbances, 74 mental retardation, 5 visual impairment, 3 cleft lip or palate, and 19 other disorders. The perpetrator was either a relative or a "trusted other" in 97.2% of sexual abuse cases. Handicapped males were much more likely to be victims of sexual abuse than nonhandicapped males in the general population. Children being educated in residential schools were more likely to be sexually abused than mainstreamed youngsters. These children may be at risk for abuse from a wide variety of potential perpetrators, including teachers, dormitory counselors, van drivers, clergy, classroom aides, older students, peer siblings, scout leaders, abused peers, baby-sitters, and custodians.

The effects of psychotherapy on behavior problems of sexually abused deaf children.

This study assessed the effectiveness of a broad based psychotherapeutic intervention with a sample of 72 children sexually abused at a residential school for the deaf. An untreated comparison group emerged when about half of their parents refused the offer for psychotherapy provided by the school. Treated and untreated children were randomly assigned to two assessment groups: those who participated in a pretreatment assessment and those who did not. Houseparents at the residential school used the Child Behavior Checklist (CBC) to rate the pretreatment assessment children before treatment and all 72 children one year after the implementation of psychotherapy. Children receiving therapy had significantly fewer behavior problems than children not receiving therapy. There was a differential response to therapy on the basis of sex. Boys receiving therapy had significantly lower scores on the following CBC scales than the no treatment group: Total, Internal, External, Somatic, Uncommunicative, Immature, Hostile, Delinquent, Aggressive, and Hyperactive. There were no differences on the Schizoid and Obsessive scales. Girls receiving therapy had significantly lower scores than the no treatment group on the following CBC scales: Total, External, Depressed, Aggressive, and Cruel. There were no differences on the Internal, Anxious, Schizoid, Immature, Somatic, and Delinquent scales.

Anthropometric dimensions to predict 1-RM bench press in untrained females.

BACKGROUND: Previous research has indicated a strong relationship between anthropometric dimensions and strength in males. To date, little work has been done to explore this topic in females. The purpose of this study was to determine the relationships between selected anthropometric dimensions and 1-RM bench press in untrained college females. METHODS: Untrained college females (n = 113) were evaluated for 18 measured and seven derived anthropometric variables to predict 1-RM bench press strength. Triplicate measurements were averaged for five skinfolds, five circumferences, and six skeletal widths. Derived measurements included Body Mass Index, percent fat, fat-free mass (FFM), flexed arm cross-sectional area (CSA), shoulder width: hip width ratio, androgyny index, and somatotype. RESULTS: Highest zero-order correlations with bench press were arm CSA (r = 0.45), flexed arm circumference (r = 0.45), mesomorphy (r = 0.44), and forearm circumference (r = 0.42). First-order partial correlations holding constant body mass or FFM generally decreased most correlations with bench press (r < 0.30). Factor loadings were used to produce muscle, length, and fat components which were placed in a multiple regression analysis to predict bench press but resulted in only limited success (R = 0.58, SEE = +/- 5.6 kg). Coefficients of variation (SEE/Mean x 100) for the equations ranged from was 18.9% to 21.0%. CONCLUSIONS: Prediction of bench press strength from anthropometric dimensions does not appear to be practical or accurate in untrained females.

Dealing with the unsafe student in clinical practice.

How do social justice issues affect the clinical evaluation of students? An emotionally charged issue, clinical evaluation can become a mine field when it becomes entangled with issues of social justice. The authors discuss the issues of justice and fairness in relation to situations that arise when a student repeatedly fails to meet minimum expectations for clinical performance. They discuss policies developed to deal with such situations and describe the application of these policies in a case study.

Pituitary--adrenal response to capture in Cayo Santiago--derived group M rhesus monkeys.

113 rhesus monkeys, representing 4 age classes, 3 matrilines, and immigrant adult males in a 161-member Cayo Santiago-derived troop living in a 2-acre enclosure, were sampled for levels of plasma ACTH and cortisol during a period of capture and brief cage confinement for routine veterinary examination. ACTH levels showed significant decreases over initially high values following capture in all subjects except infants, whereas cortisol levels remained elevated throughout the sampling period. Members of the lowest-ranking matriline had significantly higher ACTH levels than members of the other matrilines and immigrant males. Infants and juveniles exhibited higher cortisol levels than adolescent and adult monkeys. The overall pattern of results was generally consistent with previous findings from laboratory studies, providing not only evidence of generality across conditions and subject populations but also the basis for more detailed subsequent analyses of the relationship between pituitary-adrenocortical responsiveness, behavioral response to challenge, and age-sex-dominance status in wild-born rhesus monkeys.

Meeting the challenge of developing courses for distance delivery: two different models for course development.

Nursing education is increasingly challenged to convert traditional course offerings to distance delivery modalities to accommodate practicing RNs who wish to pursue continuing education. There is a lack of understanding regarding the experiences of faculty and staff from other departments within the university in the development of distance education courses. The purpose of this descriptive study was to uncover the experiences of nursing faculty and members of a university support unit involved in interdisciplinary development of distance delivery courses. Interviews were conducted with 11 participants. Two organizational models were identified. Other issues that emerged in the development of distance delivery courses were: faculty ownership of distance courses; workload implications for faculty; clinical practice by distance; and faculty expertise in new technologies. Implications for incorporating the challenges facing nursing faculty in the 21st century in the development of distance delivery courses are discussed.

Assessment of continuing nursing education needs: a literature review.

Continuing education literature is replete with disagreement and confusion regarding the value and methods of conducting needs assessments for nurses. Literature that describes the usefulness of needs assessment ranges from fuzzy rhetoric to sound empirical studies of learners' needs. Sorting through the numerous articles is a difficult and tedious task for the continuing education planner. In addition, the lack of consistency in the writings makes comparison of needs assessment findings onerous. This article presents a synthesis and critical analysis of the needs assessment literature in nursing. One hundred and thirty-two articles and books were reviewed, and four major themes emerged from the analysis.

Empowering nurses for politically astute change in the workplace.

While studies of the shortage of nurses have documented the need for nurses to play a greater role in decision-making processes in their workplaces, it cannot be assumed that nurses have the confidence or skills for making changes in the workplace in politically astute ways that will be effective. This article describes a continuing education program that was designed to prepare nurses to realize their potential power and to develop skills for effectively bringing about changes in their workplaces. Based on a feminist model of empowerment, the program content and methods reflected three dimensions of empowerment: consciousness-raising, building self-esteem, and skill development. Both short- and long-term evaluations (immediate and at 7 months) demonstrated that education can be a vehicle for empowering nurses to effectively bring about changes in their workplaces. The program was sponsored by the Manitoba Nurses Union, The University of Manitoba Continuing Education Division, and The University of Manitoba School of Nursing.