Correlates of wellbeing among African American lesbians.

Although there is a growing body of knowledge about health among African American women in general, there is a dearth of information on African American lesbians. The primary purpose of this study was to investigate the correlates of health-related quality of life among African American lesbians using a cross-sectional anonymous survey with topics and measures developed by members of the African American lesbian community. Surveys were completed by 123 English speaking adult women who identified as African American lesbians and were attending the Zuna Institute's National Black Lesbian Conference. Overall, we found a very high health-related quality of life, in spite of a high frequency of health impairments. The average body mass index (BMI) for this sample was 32.2 (SD = 8.0); 13% were morbidly obese, having a BMI of 40 or more and only 15% of the women were in a healthy weight range; advancing age was associated with poorer physical functioning, decreased physical role functioning, and more pain. Health-related quality of life was associated with depression and spirituality, but not religion. This study highlights the need for subjective measures of health-related quality of life as well as checklists of diseases and disorders.

The last drag: an evaluation of an LGBT-specific smoking intervention.

Many studies in the past 20 years have documented that lesbian, gay, bisexual, and transgender (LGBT) individuals smoke at rates that exceed the general population, yet, there have been few reports of smoking cessation interventions targeting this population. This study reports on data from 233 participants in The Last Drag, a seven-session, six-week group education and support intervention tailored for LGBT smokers. Data on smoking rates were collected during the first and last sessions, and at one, three, and six months post-intervention. As with many interventions over time, missing data is a challenge in determining success rates, but even using the most conservative estimates, nearly 60% were smoke-free at the end of the intervention, and 36% remained smoke-free by six months post-intervention. This success rate is comparable to, or better, than many mainstream smoking cessation interventions reported in the literature. The Last Drag is an effective, low-cost, LGBT-specific community intervention that can be replicated in other communities.

Unmet mental health and substance abuse treatment needs of sexual minority elders.

In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indicated that elders 55-64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utilization was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed.

An assessment of the screening performance of a single-item measure of depression from the Edmonton Symptom Assessment Scale among chronically ill hospitalized patients.

CONTEXT: Few studies have examined the validity of using a single item from the Edmonton Symptom Assessment Scale (ESAS) for screening for depression. OBJECTIVES: To examine the screening performance of the single-item depression question from the ESAS in chronically ill hospitalized patients. METHODS: A total of 162 chronically ill inpatients aged 65 and older completed a survey after admission that included the well-validated, 15-item Geriatric Depression Scale (GDS-15) and four single-item screening questions for depression based on the ESAS question, using two different time frames ("now" and "in the past 24 hours") and two response categories (a 0-10 numeric rating scale [NRS] and a categorical scale: none, mild, moderate, and severe). RESULTS: The GDS-15 categorized 20% (n = 33) of participants as possibly being depressed with a score ≥ 6. The NRS for depression "now" achieved the highest level of sensitivity at a cutoff ≥ 1 (68.8%), and an acceptable level of specificity was obtained at a cutoff of ≥ 5 (82.2%). For depression "in the past 24 hours," a cutoff of ≥ 1 achieved a sensitivity of 68.8% and a cutoff of ≥ 7 a specificity of 80.3%. For the categorical scale, a cutoff of "none" provided the best level of sensitivity for depression "now" (65.6%) and "in the past 24 hours" (81.3%), with an acceptable level of specificity being obtained at ≥"mild" (68.8%) and ≥"moderate" (68.8%), respectively. CONCLUSION: These single-item measures were not effective in screening for probable depression in chronically ill patients regardless of the time frame or the response format used, but a cutoff of ≥ 5 or "mild" or greater did achieve sufficient specificity to raise clinical suspicion.

Total laparoscopic hysterectomy: evaluation of an evidence-based educational strategy using a novel simulated suture and knot-tying challenge, the "holiotomy".

Objective. The purpose of this study was to evaluate perceptions of skills and practice patterns of gynecologists attending a course on total laparoscopic hysterectomy (TLH). This course employed extensive use of pelvic trainer boxes to accomplish the Holiotomy Challenge. The "Holiotomy Challenge" entailed suturing two plastic pieces with six figure-of-N sutures tied with four square knots each. Methods. A survey was administered before the course and 3 months later. Data were analyzed by paired t-tests, McNemar's Chi Squares, and ANCOVAs with significance set P < .05. Results. At baseline, 216 surgeons and at 3 months 102 surgeons returned the survey. Surgeons' self-perceptions of their skills significantly increased from 6.24 to 7.28. Their reports of their surgical practice at home revealed significantly increased rates of minimally invasive procedures, from 42% to 54%. Significantly more surgeons reported having the ability to close the vagina, or a small cystotomy or enterotomy. Participation in the cadaver lab and presence of their practice partner did not impact these rates. Conclusions. A comprehensive course employing laparoscopic surgical simulation focused on basic surgical skills essential to TLH has a positive impact on attendees' self-rated skill level and rate of laparoscopic approaches. Many had begun performing TLH after the course.

Smoking and behavioral health of women.

BACKGROUND: Using data from a study of reliability and validity of a screening tool for co-occurring substance abuse and mental health problems, our objective was to compare behavioral health issues of female smokers and nonsmokers and explore correlates of smoking. METHODS: Using a convenience sample (n=1021), we recruited participants to complete an online survey conducted in substance abuse treatment, primary care, mental health services, senior, and public settings. The survey included demographic questions, smoking status, the co-occurring disorders screening tool, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) and the Postraumatic Stress Disorder Checklist (PCL)-Civilian. RESULTS: One third of participants self-identified as smokers, and African American, American Indian, and bisexual women reported the highest rates of smoking. Seventy-two percent of women reported at least one mental health problem in the past year; 29% had a past year substance abuse problem, and 26% reported a past year co-occurring disorder of both. Smokers had significantly higher rates of posttraumatic stress disorder (PTSD), past year depression and anxiety, suicidality, past year substance abuse, and co-occurring disorders. Smokers also had significantly higher rates of lifetime intimate partner violence (IPV) and childhood abuse. CONCLUSIONS: Smoking in women was associated with significantly higher rates of mental health and substance abuse problems. Substance abuse, being in a treatment setting, IPV, African American and mixed ethnicity, Medicaid insurance status, reduced income, and no home ownership were identified as predictors of smoking. Screening and evaluation of smoking status, mental health, substance use disorders, and the presence and impact of violence are essential for women's health.

Longitudinal assessment of symptom severity among hospitalized elders diagnosed with cancer, heart failure, and chronic obstructive pulmonary disease.

BACKGROUND: Pain, dyspnea, and anxiety are common among patients with cancer, heart failure (HF), and chronic obstructive pulmonary disease (COPD), yet little is known about the severity of symptoms over time. OBJECTIVE: To determine the prevalence, severity, burden, and predictors of symptoms during the course of hospitalization and at 2 weeks after discharge. DESIGN: A prospective cohort study. SETTING: A large academic university. PATIENTS: Patients were 65 years or older with a primary diagnosis of cancer, COPD, or HF. MEASUREMENTS: Daily living skills and depression were recorded at enrollment. Symptoms were assessed daily and 2 weeks postdischarge. RESULTS: At baseline, most participants reported moderate/severe pain (54%), dyspnea (53%), and anxiety (62%). Almost two-thirds (64%) had 2 or more symptoms at a moderate/severe level. The prevalence of moderate/severe symptoms decreased at the 24-hour assessment (pain = 42%, dyspnea = 45%, anxiety = 55%, burden = 55%) and again at follow-up (pain = 28%, dyspnea = 27%, anxiety = 25%, burden = 30%). While there was no association between primary diagnosis and symptom severity at baseline or 24-hour assessment, at 2-week follow-up, a higher percentage of patients with COPD had moderate/severe pain (54%, χ(2) = 22.0, P = 0.001), dyspnea (45%, χ(2) = 9.3, P = 0.05), and overall symptom burden (55%, χ(2) = 25.9, P = 0.001) than those with cancer (pain = 22%, dyspnea = 16%, symptom burden = 16%) or HF (pain = 25%, dyspnea = 24%, symptom burden = 28%). Predictors of symptom burden at follow-up were COPD (odds ratio [OR] = 7.5; 95% confidence interval [CI] = 2.0, 27.7) and probable depression (OR = 6.1; 95% CI = 2.1, 17.8). CONCLUSION: The majority of inpatients with chronic illness reported high severity of symptoms. Symptoms improved over time but many patients, particularly those with COPD, had high symptom severity at follow-up.

Lesbian, gay, bisexual, and transgender (LGBT) physicians' experiences in the workplace.

Little is known about the experiences of lesbian, gay, bisexual, and transgender (LGBT) physicians in the workplace. There is little formal education in medical school about LGBT issues, and some heterosexual physicians have negative attitudes about caring for LGBT patients or working with LGBT coworkers, setting the stage for an exclusive and unwelcoming workplace. The current study used an online survey to assess a convenience sample of 427 LGBT physicians from a database of a national LGBT healthcare organization, as well as a snowball sample generated from the members of the database. Although rates of discriminatory behaviors had decreased since earlier reports, 10% reported that they were denied referrals from heterosexual colleagues, 15% had been harassed by a colleague, 22% had been socially ostracized, 65% had heard derogatory comments about LGBT individuals, 34% had witnessed discriminatory care of an LGBT patient, 36% had witnessed disrespect toward an LGBT patient's partner, and 27% had witnessed discriminatory treatment of an LGBT coworker. Few had received any formal education on LGBT issues in medical school or residency. It appears that medical schools and health care workplaces continue to ignore LGBT issues and operate in discriminatory fashion far too often.

Lesbian, gay, bisexual, transgender, and queer/questioning nurses' experiences in the workplace.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) nurses constitute one of the largest subgroups within the profession of nursing, yet there is very little empirical research in the nursing literature and virtually no attention to issues of discrimination and exclusion in the workplace by nursing education or professional nursing organizations. This study reports the findings of an online survey of 261 LGBTQ nurses from a database of an LGBTQ health advocacy organization. The survey contained both quantitative and qualitative items and revealed that many workplaces lacked policies and procedures that would make LGBTQ nurses feel safer and more included and that many coworkers, supervisors, and patients had exhibited discriminatory behavior or verbal harassment, sometimes leading to significant consequences for the LGBTQ worker. LGBTQ nurses expressed a need for a professional organization that would educate the nursing profession and the general population about LGBTQ issues and address their advocacy and health care policy needs. Efforts to correct the current workplace climate for LGBTQ employees would involve (a) changes in workplace policies, (b) education of the health care workforce, and (c) advocacy from nursing professional organizations.

Validity and reliability of the COJAC screening tool for co-occurring disorders.

This study explored the reliability and validity of a nine-item screening tool (Co-Occurring Joint Action Council [COJAC] Screening Tool [CST]) for co-occurring disorders (COD). Using a convenience sample (n=1,951), an online survey was conducted in multiple settings and included demographic questions, the CST, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), and the Posttraumatic Stress Disorder Checklist-Civilian version. The CST substance abuse (SA) scale performed well with a Cronbach's alpha of .84 and a correlation of .71 with GAIN-SS SA (past year). The CST mental health and trauma items did not perform well as scales with Cronbach's alphas of .64 and .56, respectively. The CST-SA is a short, reliable, and valid measure of SA. Further study is needed to determine the best evaluation tool for the mental health portion of the COD screening instrument.

The relationship of chemotherapy-induced nausea to the frequency of pericardium 6 digital acupressure.

PURPOSE/OBJECTIVES: To explain the relationship between the intensity of chemotherapy-induced nausea (CIN) and the frequency of pericardium 6 (P6) digital acupressure. DESIGN: Secondary data analysis of a multicenter, longitudinal, randomized, clinical trial. SETTING: Nine community clinical oncology programs and six independent sites in the United States. SAMPLE: 53 patients with breast cancer who received moderate to highly emetogenic chemotherapy and applied P6 digital acupressure in addition to antiemetics to control CIN. METHODS: A daily log measuring nausea intensity and the frequency of acupressure for 11 days after the administration of chemotherapy. Hierarchical generalized linear modeling procedure (multilevel negative binomial regression) was used for analyzing the data. MAIN RESEARCH VARIABLES: Nausea intensity and acupressure frequency. FINDINGS: Participants used acupressure an average of two times per day (SD = 1.84, range 0-10). Women who used acupressure more frequently after the peak of nausea (on day 4) were predicted to have a 0.97-point higher nausea intensity in the acute phase than women who used acupressure less frequently, controlling for the effects of other variables in the model (incidence rate ratio = 1.52, p < 0.01). CONCLUSIONS: Patients with breast cancer whose nausea intensity started higher from the acute phase continued to experience higher symptom intensity during the 11 days after chemotherapy administration and required more frequent acupressure even after the peak of nausea. IMPLICATIONS FOR NURSING: Careful assessment and management of acute CIN with continuous monitoring and care of CIN in the delayed phase are important nursing issues in caring for patients receiving chemotherapy.

Nursing's silence on lesbian, gay, bisexual, and transgender issues: the need for emancipatory efforts.

The purpose of this study was to selectively review the nursing literature for publications related to lesbian, gay, bisexual, and transgender health, using (1) a key word search of CINAHL, the database of nursing and allied health publications; (2) from the top-10 nursing journals by 5-year impact factor from 2005 to 2009, counting articles about lesbian, gay, bisexual, and transgender issues; and (3) content analysis of the articles found in those journals. Only 0.16% of articles focused on lesbian, gay, bisexual, and transgender health (8 of nearly 5000 articles) and were biased toward authors outside of the United States. We discuss the impact of this silence.

Risk factors for reproductive and breast cancers among older lesbians.

OBJECTIVE: To determine if older lesbians have more breast and gynecological cancer risk factors compared with their heterosexual sisters. METHODS: Using multiple methods, including respondent-driven sampling with the lesbian as the index participant, a sample of 370 lesbian-heterosexual sister pairs aged >or=40 completed an anonymous survey about their health. For this secondary data analysis, we extracted data on an older subset of this group, those sister pairs with at least one sister >50 years (n = 42 pairs or 84 women). For this project, we explored the breast and gynecological risk factors for cancer in these women. Comparisons between the sisters were generated using paired t tests, analysis of variance (ANCOVA), and McNemar's chi-square. RESULTS: Compared with their sisters, lesbians had significantly more education (p < 0.001), fewer pregnancies (p < 0.001), less total months pregnant (p < 0.001), fewer children (p < 0.001), and fewer total months breastfeeding (p < 0.001). Lesbians in this sample tended to have higher body mass indices (BMI) (p = 0.08) and to exercise fewer times per week (p = 0.07). Differences in smoking and alcohol use were not statistically significantly different. The lesbians performed breast self-examinations significantly less than their sisters (p < 0.05). CONCLUSIONS: These findings suggest that older lesbians may have greater risk factors for some, not all, reproductive cancers when compared with their heterosexual sisters, specifically, increased risk for breast, ovarian, and endometrial cancer but decreased risk for cervical cancer. Further research should be done to determine if these risks translate into actual disease for lesbians as well as culturally appropriate ways to modify the risks among lesbians.

Sexual and physical abuse: a comparison between lesbians and their heterosexual sisters.

The purpose of this study was to investigate similarities and differences in the incidence and patterns of abuse experienced by lesbians and their heterosexual sisters. In a matched sample of 324 lesbian/heterosexual sister pairs, the lesbians reported a greater incidence than their sisters of childhood physical and sexual abuse, as well as adult sexual abuse. Both groups identified male relatives as the most common perpetrator of both childhood physical and sexual abuse. Male relatives were most commonly identified as perpetrators of adult physical abuse and male strangers were most commonly identified as adult sexual abusers. Our results demonstrate that both sexual and physical abuse are common experiences for lesbian and heterosexual women; however, since the context of these experiences is different, each group will have special needs for services and treatment.

Nausea at the end of adjuvant cancer treatment in relation to exercise during treatment in patients with breast cancer.

PURPOSE/OBJECTIVES: To evaluate the relationship between nausea and exercise during and after adjuvant cancer treatment (chemotherapy and radiation therapy or chemotherapy alone). DESIGN: Secondary data analysis from a longitudinal, single-blinded, three-arm, randomized controlled trial. The trial failed to show a significant effect of an exercise intervention on nausea control (by intent to treat analysis); therefore, patients were analyzed together to evaluate the relationship between nausea and actual exercise behavior. SETTING: Outpatient cancer treatment clinics. SAMPLE: 112 female patients with breast cancer who were receiving adjuvant cancer treatment. METHODS: Actual exercise behavior-based analysis was conducted with nausea intensity and the participant's exercise status measured three times during and after adjuvant cancer treatment. Participants were considered exercisers if actual exercise behaviors corresponded to the recommendation of the American College of Sports Medicine: aerobic exercise at a minimum of moderate intensity, 20 minutes per session, and three times per week. Mann-Whitney U tests evaluated the difference in nausea intensity depending on actual exercise status. MAIN RESEARCH VARIABLES: Nausea intensity and exercise status. FINDINGS: Exercisers experienced significantly less intense nausea than nonexercisers at the completion of adjuvant cancer treatment. CONCLUSIONS: A moderate level of aerobic exercise is related to less intense nausea at the completion of adjuvant cancer treatment. IMPLICATIONS FOR NURSING: A moderate level of aerobic exercise is recommended during adjuvant cancer treatment because of the possibility of reducing nausea intensity as well as alleviating other symptoms from adjuvant cancer treatment.