Acculturative stress in Korean Americans.

BACKGROUND: Acculturative stress is known to contribute to chronic diseases among many immigrants and yet this association in Korean Americans remains unclear. AIM: The study purpose was to examine the level of acculturative stress in Korean Americans and to determine if correlations existed with personal and physiological factors. METHODS: An exploratory, cross-sectional, descriptive study was conducted in a sample of 107 Korean American adults. Data on acculturative stress and personal factors were collected using a survey questionnaire in addition to a direct measure of physiological factors (i.e., body mass index and blood pressure). RESULTS: All 107 participants were first-generation Koreans. Most participants were women (66.4%), with a mean age of 53.9±10.7, married (88.8%), and with a college education (84.2%). Acculturative stress was associated with a number of personal factors (i.e., arrival age, years of U.S education, years of U.S. residency, English proficiency), and the personal factors of gender, age, employment status, and years of U.S. residency were associated with the physiological factors. No statistically significant associations were found between acculturative stress and physiological factors. CONCLUSIONS: The mean acculturative stress score in this study was higher than findings from prior studies of Korean immigrants in the United States or Canada, with the rates of obesity and hypertension higher than prior reports of Korean Americans or Koreans residing in Korea. Future study is necessary with a larger sample from a variety of different geographic areas of the United States to examine further the impact of acculturative stress on physiological factors during the process of acculturation.

Transitions in Symptom Cluster Subgroups Among Men Undergoing Prostate Cancer Radiation Therapy.

BACKGROUND: Prostate cancer is a common type of cancer worldwide and in the United States. However, little information has been reported on the symptoms of men over time who receive radiation therapy. OBJECTIVE: The objectives of this study were to identify subgroups of men at pre- and post-radiation therapy on general and treatment-related symptoms and to determine transitions in subgroup membership over time. METHODS: Men (n = 84) receiving radiation therapy completed questionnaires on fatigue, insomnia, pain, depression, anxiety, and sexual, urinary, and bowel problems at pretreatment and posttreatment. Latent class analysis identified subgroups. One-way analyses of variance determined subgroups differed on symptoms, participant characteristics, and quality of life. Latent transition analysis examined subgroup transitions over time. RESULTS: At pretreatment, 4 subgroups were identified: resilient group, with little to no symptom reporting; adjusted group, with moderately high treatment-related symptoms, low insomnia, depression, and anxiety; distressed group, consistently high on most symptoms; and emerging group, with moderately high fatigue, depression, and anxiety with few treatment-related symptoms. At posttreatment, similar results were seen in groups to those at pretreatment: resilient, adjusted. and distressed groups with an impacted group having high pain, insomnia, depression, and urinary and bowel symptoms. Quality of life and participant characteristics further distinguished groups at pretreatment and posttreatment. Income level predicted a transition in group membership. CONCLUSIONS: Men can be classified into distinctly different subgroups over time. IMPLICATIONS FOR PRACTICE: Assessment and intervention with men in subgroups such as distressed and emerging before and during treatment may lessen potential for remaining distressed or moving into impacted group where symptom severity is high at posttreatment. Interventions to reduce multiple symptoms are vitally needed.

Association of symptoms and cytokines in prostate cancer patients receiving radiation treatment.

INTRODUCTION: Men with prostate cancer undergoing radiation treatment frequently report fatigue, insomnia, depression, anxiety and urinary, bowel, sexual, and hormonal symptoms. Plasma concentrations of cytokines may be related to these symptoms, but few studies have examined these relationships. The study purpose was to explore the association between prostate cancer symptoms and cytokine levels at pretreatment and posttreatment. METHOD: In this longitudinal, correlational study, 29 men with nonmetastatic prostate cancer completed symptom questionnaires at preradiation and postradiation treatment. Blood drawn at these same time points was used to determine levels of tumor necrosis factor-alpha (TNF-α) and interleukins-1ß, 6, 10, and 4 (IL-1ß, IL-6, IL-10, and IL-4). RESULTS: Men reported symptom severity at pretreatment and posttreatment as low to moderate. There were significant differences from pretreatment to posttreatment in fatigue, insomnia, urinary irritative and incontinence, bowel, sexual, and hormonal problems. There were no significant differences in TNF-α, IL-6, IL-10, or IL-4. At pretreatment, TNF-α was associated with depression, anxiety, urinary irritative, and bowel problems, and IL-4 was related to urinary irritative symptoms. At posttreatment, IL-4 was associated with urinary irritative symptoms. Findings suggest that, in men with prostate cancer, there is no strong association between symptom reporting and cytokine levels. Ongoing research focused on neuroendocrine and genetic markers and their associations with symptoms is promising and may result in the provision of better markers for quantifying the symptom experience in patients with cancer.

Fatigue-based subgroups of breast cancer survivors with insomnia.

The purpose of this study was to determine if breast cancer survivors (BCS) with insomnia can be grouped according to their level of fatigue. A secondary data analysis was conducted on baseline data obtained from a randomized clinical trial that focused on a cognitive-behavioral intervention for insomnia in BCS. Participants were BCS (n = 86) with insomnia who were at least 3 months after completion of primary treatment without current evidence of disease. Three subgroups of women were identified with significant differences in fatigue, including exhausted (35%), tired (41%), and restored (24%). Results suggest that most women have moderate to severe fatigue many years after completion of treatment. Severe fatigue was associated with higher levels of other symptoms and poorer quality of life (exhausted subgroup). Significant differences in insomnia severity, anxiety, depression, and quality of life were noted among the exhausted, tired, and restored subgroups. The existence of fatigue-based subgroups offers important information when providing care to BCS. By determining symptoms associated with fatigue, patient care will benefit through a shift in focus from treatment of a single symptom such as fatigue to the delivery of a tailored intervention that targets multiple symptoms.

Insomnia, depression, and distress among outpatients with prostate cancer.

Limited information is known about insomnia, depression, and distress in men with prostate cancer. This study explored insomnia and its relationship to depression and distress in this population. Participants (N = 51) were recruited from a Veterans Affairs Medical Center outpatient clinic. Questionnaires included the Insomnia Severity Index, Center for Epidemiologic Studies-Depression Scale, and Impact of Event Scale. Findings indicated that many men had insomnia and depression with a moderate level of distress. Half the men with clinically significant insomnia also had clinically significant depression. Significant relationships were found among insomnia, depression, and distress. Implications for research and practice are offered.

Review and critique of the literature of complementary and alternative therapy use among Hispanic/Latino women with breast cancer.

Healthcare providers often care for patients who use complementary and alternative therapy (CAT). Despite recent advances in cross-cultural research, little is known about how Hispanic/Latino women being treated for breast cancer use CAT to manage the disease and the side effects of treatment. A woman's cultural heritage, education, healthcare beliefs, degree of acculturation, and socioeconomic factors influence her decision to use CAT and the choice of a specific CAT. Only five studies specifically investigating CAT use by Hispanic/Latino women with breast cancer have been published, and more research in this area is needed. Although information about CAT use by this population is limited, nurses can use it to promote culturally sensitive care.

Well-being in Hispanic and non-Hispanic white survivors of breast cancer.

PURPOSE/OBJECTIVES: To test a well-being model on Hispanic and non-Hispanic white survivors of breast cancer by comparing responses about variables hypothesized to predict well-being. MAIN RESEARCH VARIABLES: Healthcare orientation, uncertainty, social support, resourcefulness, self-esteem, and well-being. DESIGN: Descriptive and comparative. SAMPLE: 50 Hispanic and 50 non-Hispanic white women who completed treatment for breast cancer and were disease-free. SETTING: Regional cancer center in southwestern United States. METHODS: Subjects completed the Psychosocial Adjustment to Illness Scale-Health Care Orientation Subscale, Mishel Uncertainty Illness Scale, Personal Resource Questionnaire, Self-Control Schedule, Self-Esteem Inventory, and Index of Well-Being. FINDINGS: Both groups of women reported high well-being. Sample characteristics were not related significantly to well-being in either group. No statistically significant differences were found between Hispanic and non-Hispanic white women on any variables. CONCLUSIONS: Comparison of well-being models revealed similarities between the two groups, including variables entering each regression equation, and explained variance. Further research is needed to explore whether commonalities in women's responses to breast cancer exist independent of ethnicity. IMPLICATIONS FOR NURSING: Nurses should continue encouraging both Hispanic and non-Hispanic white women to share concerns and seek information from healthcare providers while strengthening feelings of self-worth because these factors directly affect well-being.