The Influence of Comorbidities, Risk Factors, and Medications on Sexual Activity in Individuals Aged 40 to 59 Years With and Without Cardiac Conditions: US National Health and Nutrition Examination Survey, 2011 to 2012.

BACKGROUND: Sexual activity is increasingly recognized as an important aspect of quality of life for many individuals with cardiovascular disease, although less is known about the factors contributing to sexual functioning in younger adults. OBJECTIVE: This study examined factors influencing sexual activity in individuals aged 40 to 59 years, comparing those reporting a cardiac condition with those without a cardiac condition, in a national population-based sample. METHODS: The data were derived from the 2011 to 2012 National Health and Nutrition Examination Survey, a publicly available data set with a noninstitutionalized nationally representative sample. The sample included individuals between the ages of 40 and 59 years (N = 1741) who completed relevant items related to cardiovascular disease, cardiovascular risk factors, comorbidities, cardiac symptoms, sexual activity, and medication use. Recommended weighting was applied, and the data were analyzed using χ and logistic regression. RESULTS: Overall, 94% of the sample reported sexual activity, although those with coronary artery disease, angina, and myocardial infarction engaged in significantly less sexual activity. Individuals who smoked; had a weight problem, depression, or lung problems; or experienced symptoms of shortness of breath or chest pain with exertion reported less sexual activity. Medications negatively affecting sexual function were central α agonists, potassium sparing diuretics, and antilipidemic agents. Predictors of less sexual activity were smoking, chest pain walking uphill, and weight problems. Unexpectedly more reported, sexual activity was predicted by one or more cardiac conditions. CONCLUSION: In men and women ages 40 to 59 years, certain cardiac conditions, risk factors, comorbidities, symptoms, and medications negatively affected sexual activity, illustrating the need for sexual assessment and counseling to support sexual quality of life.

Depression, Quality of Life, Physical Activity, and the Impact of Drugs on Sexual Activity in a Population-Based Sample, Ages 20-59 Years.

Sexual quality of life is important for many individuals; therefore, this study examined the frequency of depression in a younger and middle-aged population-based sample, and the impact on physical activity, quality of life, and sexual activity, and the role of antidepressant and cardiac drugs on sexual function. The sample, ages 20 to 59 years, completed relevant items for depression, sexual activity, physical activity, quality of life, and drugs. Data were analyzed using descriptive statistics, Pearson correlations, t-tests, and analysis of variance. Those sexually active had lower mean depression scores and higher ratings of quality of life, while those sexually inactive had greater depression and took more drugs. Thorough assessment of drugs, depression, cardiac and other medical conditions, and interest and engagement in sexual activity should be routinely assessed in all patients, regardless of age.

Sexual concerns of cardiac patients: A psychometric analysis.

The primary aim of this study was to evaluate the psychometric properties of the Steinke Sexual Concerns Inventory-General Cardiac Version (SSCI-GCV) and to examine its use across multiple cardiac diagnoses. A sub-analysis of a cross-sectional sample of 205 cardiac patients from the central USA was completed. Our analyses yielded promising evidence that the SSCI-GCV is a reliable (Cronbach's alpha = 0.86) and valid measure of sexual concerns and supported three subscales for this 11-item instrument. Further means testing suggested that participants with a diagnosis of stroke or kidney disease reported more sexual concerns than those without such diagnoses, but differences were not found for any specific cardiac health problem or intervention. These findings support the use of the SSCI-GCV as a brief and easily administered instrument that can be used to broadly assess sexual concerns in cardiac populations and to inform sexual counselling of cardiac patients in practice.

Change in sexual activity after a cardiac event: the role of medications, comorbidity, and psychosocial factors.

AIM: The aim of this study was to examine change in sexual activity before and after cardiac diagnosis in men and women by medication class. BACKGROUND: Decline in sexual activity after cardiac diagnosis frequently occurs, with adverse effects of medications believed to play a role, although literature by subclass of drugs are conflicting. METHODS: Mixed methods approach was used to evaluate cardiac patients' (N=211) self-reported medications and changes in sexual activity before and after cardiac diagnosis via mailed survey. Chi square, logistic regression, and thematic analysis were used. RESULTS: First and third generation beta blockers, class 1 calcium channel blockers, vasodilators, diuretics, and loop diuretics adversely affected sexual activity. Significant predictors of change in sexual activity were number of medications, education level, and income; the overall model predicted 25.7% of the variance in sexual activity. CONCLUSIONS: Sexual assessment and discussion of sexual concerns and side effects of medications by nurses are important to support sexual function.

Risk Factors, Depression, and Drugs Influencing Sexual Activity in Individuals With and Without Stroke.

PURPOSE: The aim of the study was to analyze factors affecting sexual activity in individuals with and without stroke, ages 40-59 years, in a national, cross-sectional, population-based sample derived from the National Health and Nutrition Examination Survey (NHANES). DESIGN: Descriptive, cross-sectional survey. METHODS: Data were obtained from the NHANES (2011-2012) data set from individuals (N = 3,649) completing items related to cardiovascular risk factors, drugs, and sexual activity. Data were analyzed using chi-square, t tests, and logistic regression. FINDINGS: Overall, number of drugs, smoking, and depression significantly predicted sexual activity. When comparing sexually active to not sexually active, those with stroke had significantly less sexual activity (t = 2.822, p = .005) and reduced sexual activity per week or month (χ = 16.275, p = .005, df = 4). Those taking angiotensin-converting enzyme inhibitors and statins had reduced sexual activity. CONCLUSIONS/CLINICAL RELEVANCE: Findings illustrate the importance of risk factor modification and nurses engaging in sexual assessment, education, and counseling to support sexual quality of life in younger individuals with stroke.

The Impact of Foster Care and Temporary Assistance for Needy Families (TANF) on Women's Drug Treatment Outcomes.

This study assesses the impact of having a child in foster care and receiving cash benefits through Temporary Assistance for Needy Families (TANF) on women's completion of a residential drug treatment program. The study's hypothesis was that drug treatment completion rates for women who had children in foster care and/or who were receiving TANF would differ from women who did not receive these services. The sample included 117 women age 19 to 54, in a Midwestern state. Findings suggest that women with a child or children in foster care were less likely to complete treatment. Women receiving cash benefits were also somewhat less likely to complete treatment than women not receiving these services. Women with children in foster care had similar levels of psychological, employment, and drug and alcohol concerns as other women, as measured by the Addiction Severity Index. Future research should focus on identifying strategies that enhance retention rates of these vulnerable women. Implications for improving treatment retention are discussed in light of the Adoption and Safe Families Act of 1997 and the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

Predictors of change in sexual activity after cardiac diagnosis: Elements to inform sexual counseling.

Safely returning to sexual activity after being diagnosed with a cardiac condition is at the core of sexual counseling strategies. To further inform sexual counseling, this study examined changes in sexual activity before and after a cardiac diagnosis. Logistic analysis was used to suggest factors that can contribute to a change in sexual activity among cardiac patients. Reduced frequency in sexual activity after a cardiac diagnosis was influenced by greater sexual concerns and a history of smoking, as well as by education and employment status. These findings suggest that cardiac patients experiencing significant concerns about resuming sexual activity need added support through the mental health system.

Medication use and predictors of sexual activity in men and women with CVD.

PURPOSE: To examine the influence of cardiac and noncardiac medications on sexual activity by drug classification and generation of the drug, among men and women with cardiovascular disease. DATA SOURCES: This study was a subanalysis (n = 224) of survey data from a cross-sectional sample of 336 cardiac patients. Self-reported medications were categorized by generic drug name, classification, and subclass and/or generation of the drug. Sexual activity was the presence or absence of current sexual activity in the last 2 months. CONCLUSIONS: Patients taking generation one beta blockers, particularly men; diuretics as a class; and loop diuretics, were significantly less likely to be sexually active, with diuretics negatively influencing sexual activity in women, but not men. Certain antidepressant medications positively influenced sexual function, particularly for women. Nearly 20% of the variances in sexual activity were explained by younger age, fewer number of medications, higher education, and having a sexual partner. IMPLICATIONS FOR PRACTICE: A new finding meriting further study was that loop diuretics negatively impacted sexual activity, particularly for women; and further studies of women overall are clearly needed. Advance practice nurses play an important role in evaluating medications, proactively choosing drugs within a class or subclass less likely to cause sexual problems, and in promoting sexual quality of life of cardiac patients.

Baccalaureate nursing students' application of social-cognitive sexual counseling for cardiovascular patients: A web-based educational intervention.

BACKGROUND: A gap in knowledge and practice exists for sexual counseling of cardiovascular patients, and innovative approaches are needed to address patients' sexual quality of life. AIM: To evaluate a web-based social-cognitive intervention for evidence-based sexual counseling by baccalaureate nursing students with cardiovascular patients. METHODS: A pre- post-test survey design was used: pre-test (T1), immediate post-test after intervention (T2), and at 4 to 6weeks post-intervention (T3). Data were collected using the Survey of Sexuality Related Nursing Practices -Cardiac version (SSRNP-CV). Data were analyzed using descriptive statistics and t-tests. RESULTS: From T1 to T2, students (N=95) significantly increased their responsibility and confidence in sexual counseling; from T1 to T3 (N=57), students significantly improved sexual counseling for confidence and practice subscales, total SSRNP score, and cardiac-specific subscales of sexual counseling, sexual activity, and gender. CONCLUSION: This study clearly demonstrated that a web-based social-cognitive sexual counseling intervention was effective in improving students' ability to provide evidence-based sexual counseling of cardiovascular patients.

Sexual concerns of cardiac patients: predictors and the influence of specific sexual activities.

BACKGROUND: Addressing sexual concerns of cardiac patients is integral to comprehensive patient-centered nursing care, and instruments for use across cardiac populations are needed to promote this activity. Knowing the factors that contribute to sexual concerns provides insights that help to promote inclusion of assessment of relevant sexual activity and provide sexual counseling as a standard of care. AIM: This study examined demographic factors, comorbid conditions, and sexual activities as predictive of sexual concerns. Specific sexual activities and demographic variables were also examined for their relation to sexual concerns. METHODS: This study was a sub-analysis of a cross-sectional observational study testing a regression model of factors that predicted sexual concerns in a broad sample of cardiac patients in the United States, using a self-report survey method. RESULTS: More comorbidities and types of sexual activities contributed to greater sexual concerns reported by respondents. Sexual activities resulting in overall sexual concerns included hugging/kissing, oral sex, and finger penetration. Non-Whites reported more sexual concerns, sexual fears, and symptoms related to sexual activity. Those who were not working/retired from employment reported significantly more sexual concerns and dysfunction, whereas, those who had a smoking/tobacco use history reported more sexual concerns, symptoms, and dysfunction. CONCLUSION: This study underscores that cardiac patients across a variety of diagnoses and comorbidities often experience sexual concerns, fears, symptoms, and dysfunction. The strongest predictors of sexual concerns were the number of cardiac and noncardiac comorbidities, thus illustrating the importance of a thorough assessment of these factors when examining sexual concerns of cardiac patients.

Cardiac comorbidities and sexual activity predict sexual self-perception and adjustment.

BACKGROUND: Changes in sexual satisfaction and sexual activity are often reported by cardiac patients, although factors influencing sexual adjustment are not well established. Knowledge of risk and protective factors can guide nurses in addressing physical and psychological needs of patients. OBJECTIVES: We examined predictors of sexual self-perception and adjustment in a cross section of cardiac patients. METHODS: A nonexperimental, descriptive survey design was used to examine overall sexual self-perception and adjustment, sexual anxiety, sexual depression, sexual satisfaction, sexual self-efficacy, sexual activity, selected demographic factors, and 20 cardiac and noncardiac comorbidities using a mailed survey with a broad sampling of cardiac patients (n = 128). Data were analyzed with descriptive statistics, t tests, and regression analysis. RESULTS: Fewer cardiac conditions and being sexually active were significant predictors of sexual self-perception and adjustment. Participants with hypertension reported more sexual depression; those with myocardial infarction had higher scores for both sexual anxiety and depression, and greater sexual anxiety occurred for those with peripheral artery leg bypass. DISCUSSION: Positive sexual self-perception and adjustment are linked to sexual activity and fewer cardiac problems. This finding can be used to inform decisions about initiating sexual counseling.

The impact of emotional and material social support on women's drug treatment completion.

This study assessed how women's perceptions of emotional and material social support affect their completion of residential drug treatment. Although previous research has examined how social support affects recovery, few studies, if any, have examined both the types and the sources of social support. The study hypothesized that women's perceptions of the emotional and material social support they receive from family, friends, partners, drug treatment, child welfare, and welfare agencies will affect treatment completion. The sample consisted of 117 women who were enrolled in a women's residential treatment program. Data were collected in semistructured initial and follow-up interviews using a life history calendar; the Scale of Perceived Social Support, which was adapted for this study; and women's treatment records. The results support the hypothesis. Social support can have both positive and negative effects on treatment completion, depending on the type and source of support provided.

Prescription for trouble: Medicare Part D and patterns of computer and internet access among the elderly.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 specifically encourages Medicare enrollees to use the Internet to obtain information regarding the new prescription drug insurance plans and to enroll in a plan. This reliance on computer technology and the Internet leads to practical questions regarding implementation of the insurance coverage. For example, it seems unlikely that all Medicare enrollees have access to computers and the Internet or that they are all computer literate. This study uses the 2003 Current Population Survey to examine the effects of disability and income on computer access and Internet use among the elderly. Internet access declines with age and is exacerbated by disabilities. Also, decreases in income lead to decreases in computer ownership and use. Therefore, providing prescription drug coverage primarily through the Internet seems likely to maintain or increase stratification of access to health care, especially for low-income, disabled elderly, who are also a group most in need of health care access.

Grandchild, grandparent, and parent coresidence from 1970 to 1990: structural factors affecting state patterns.

This study analyzes structural forces affecting state patterns of parental presence within grandparent-grandchild coresidence by testing demographic, social change, policy environment, and social problems models. The project combines published state-level data with the 1970, 1980, and 1990 Census Public Use Microdata Samples. While factors differentially affect the proportion of children living in each household structure, coresidence seems to be encouraged by social contexts in which people are poor, the middle generation is likely to die, and which have higher rates of births to teens. State policy environment only affects proportions of children living in three generation households for 1980 and 1990. Structural variables other than social problems matter more for percent of children living in three generation households than for proportion of children living only with grandparents. Structural variables explain more variation in proportion of children living in skipped generation households than in proportion of children living with both parents and grandparents.

Grandparents in law: investigating the institutionalization of extended family roles.

Previous research on grandparents has focused on the individual and familial level and has characterized grandparent roles as ambiguous and contingent. Emphasizing instead structural phenomena, this theoretical paper argues that grandmother and grandfather roles are being institutionalized through state and federal legislation. This phenomenon provides an opportunity to investigate the process of institutionalization as it happens. Grandparenthood is evaluated as a potential site for institutionalization and law as a source of institutionalization is discussed. Preliminary evidence of the legal institutionalization of grandparenthood is presented and implications and directions for further research are suggested.