Resourcefulness and stress among hospice and palliative nurses: the role of positive thinking.

Background: Among healthcare professionals, hospice and palliative nurses have a high risk of experiencing work stress. However, little attention has been paid to protective factors that could mitigate the impact of daily stressors on hospice and palliative nurses. Aim: This study aimed to determine whether resourcefulness and positive thinking have a negative association with perceived stress among hospice and palliative nurses, and whether positive thinking moderates or mediates the link between resourcefulness and stress among hospice and palliative nurses. Method: A cross-sectional, correlational design was used to address these two aims. Results: A convenience sample of 86 hospice and palliative nurses (95% female) in the US completed an online survey. The results demonstrated that positive thinking and resourcefulness are useful predictors of stress reduction and help mitigate the effects of stress. Positive thinking did not mediate the relationship between resourcefulness and stress. Conclusion: Moderation analysis suggests that social resourcefulness may be especially helpful in reducing stress among hospice and palliative nurses with a low level of positive thinking.

Rarity and nutrient acquisition relationships before and after prescribed burning in an Australian box-ironbark forest.

Nutrient cycling is greatly influenced by dominant plants that contribute high amounts of leaf litter to soils; however, less-dominant and rare species can play keystone roles in nutrient cycling if they have unique nutrient acquisition traits and provide high-quality litter. In many parts of the world, wildfire is likely to become more frequent and intense under a changing climate. The effect this will have on plant rarity and on species with unique nutrient acquisition traits, and thus nutrient cycling, remains poorly understood. Working within an Australian box-ironbark forest, we determined if a relationship existed between species rarity and the uniqueness of their leaf nutrient profiles, and if this relationship changed after prescribed burning. We created an index of species rarity from a data set of woody perennial species abundance in areas before and after autumn or spring burns, or left unburnt. We created indices of uniqueness for the leaf nutrient profiles of 42 woody perennial species occurring in the ecosystem, based on amounts of six macronutrients and four micronutrients found in fresh and senesced leaves of each species. Five nutrient acquisition strategies (mycorrhizal, N-fixing, carnivorous, hemiparasitic and proteoid roots) were represented in the data set. There was no community-wide relationship between rarity and uniqueness of leaf nutrient profiles, and this did not change as a result of fire. However, two hemiparasitic species were relatively rare in the ecosystem studied, and differed greatly from other species due to high K and P in senesced leaves. Thus, some of the rarest species, such as hemiparasites, can be functionally unique. Understanding the functional characteristics of rare species is important so that unique functional contributors can be identified and conserved to prevent local extinction.

The effect of prescribed burning on plant rarity in a temperate forest.

Rare species can play important functional roles, but human-induced changes to disturbance regimes, such as fire, can inadvertently affect these species. We examined the influence of prescribed burns on the recruitment and diversity of plant species within a temperate forest in southeastern Australia, with a focus on species that were rare prior to burning. Floristic composition was compared among plots in landscapes before and after treatment with prescribed burns differing in the extent of area burnt and season of burn (before-after, control-impact design). Floristic surveys were conducted before burns, at the end of a decade of drought, and 3 years postburn. We quantified the effect of prescribed burns on species grouped by their frequency within the landscape before burning (common, less common, and rare) and their life-form attributes (woody perennials, perennial herbs or geophytes, and annual herbs). Burn treatment influenced the response of rare species. In spring-burn plots, the recruitment of rare annual herbs was promoted, differentiating this treatment from both autumn-burn and unburnt plots. In autumn-burn plots, richness of rare species increased across all life-form groups, although composition remained statistically similar to control plots. Richness of rare woody perennials increased in control plots. For all other life-form and frequency groups, the floristic composition of landscapes changed between survey years, but there was no effect of burn treatment, suggesting a likely effect of rainfall on species recruitment. A prescribed burn can increase the occurrence of rare species in a landscape, but burn characteristics can affect the promotion of different life-form groups and thus affect functional diversity. Drought-breaking rain likely had an overarching effect on floristic composition during our study, highlighting that weather can play a greater role in influencing recruitment and diversity in plant communities than a prescribed burn.

The struggle for schizophrenia treatment: A case study.

Individual of legal age with schizophrenia presenting anosognosia was abandoned, as a result of a court decision. Close family members were not allowed to provide medical follow-up, treatment, protection regarding his vulnerability, and preserve the dignity of their loved one. The issue was the court's prioritization of the autonomy of the individual over his mental health status. The purpose of this case study was to identify the pitfalls of a court case seeking medical follow-up and treatment for a family member with schizophrenia and anosognosia. The method was qualitative and the design was descriptive and instrumental, linking the law to the life experience resulting from the procedures for its implementation. This study examined the difference between clinical and medical-legal evaluation of the examinee. The application of the Therapeutic Jurisprudence principles to the high number of schizophrenia cases with anosognosia, the abandonment of the mentally ill, and family crisis call healthcare providers and the Judiciary for an improvement action of the process of guardianship.

Germination Ecology and Seed Dispersal of a Critically Endangered Plant: A Case Study of Pomaderris vacciniifolia (Round-Leaf Pomaderris).

Change in ecosystem disturbance regimes from human land-use poses a worldwide problem for management of rare species. Two important types of disturbance influencing the persistence of species in Australian ecosystems are habitat fragmentation and fire. In this study, seed dispersal and the germination ecology of Pomaderris vacciniifolia-a critically endangered, rare endemic Australian shrub-were examined to identify likely influences of fire and fragmentation on the decline of populations. The response of seed germination to simulated effects of wildfire and canopy openings was investigated, as was the unaided dispersal capability of seeds from parent plants. A significant increase in germination rate was observed following 100°C heat treatment to seeds, while smoke and light exposure had little influence. Seed imbibition was strongly influenced by heat treatment. The findings indicate a likely positive post-fire germination response, with implications for recruitment success determined by moisture availability following fire. Unaided seed dispersal was limited, which partly explains the apparent decline of populations. Understanding disturbance requirements for threatened species, and subsequent management of landscapes for disturbance, will aid conservation of rare species throughout the world.

Diabetic Retinopathy.

The prevalence of diabetes is on the rise globally as are the consequences, such as diabetic retinopathy. Diabetic retinopathy is a leading cause of vision loss in working-age adults in developed countries. Visual impairment as a result of diabetic retinopathy has a significant negative impact on the patient's quality of life and their ability to successfully manage their disease. Glycemic control, blood pressure normalization, and lipid management form the basis for long-term diabetes management and protection from worsening eye disease.

Novice nurses' level of global interdependence identity: a quantitative research study.

BACKGROUND: Often, therapeutic relationships are cross-cultural in nature, which places both nurses and patients at risk for stress, depression, and anxiety. OBJECTIVES: The purpose of this investigation was to describe novice nurses' level of global interdependence identity, as manifested by worldminded attitudes, and identify the strongest predictors of worldminded attitudes. DESIGN: Prospective descriptive with multiple regression study. SETTING: The various nursing units of a large hospital in the great Cleveland, OH, area. PARTICIPANTS: The participants were novice nurses up to two years after graduation from nursing school and employed as hospital clinicians. METHODS: Descriptive statistics with the mean and standard deviation of the scores was used for the delineation of the development of the participants. The study relied on a survey instrument, the Scale to Measure Worldminded Attitudes developed by Sampson and Smith (1957). The numerical data was scored and organized on a Microsoft Excel spreadsheet. The Statistical Package for Social Sciences (SPSS) version 21 was the program used to assist with analysis. The assessment of the models created through regression was completed using the model summary and analysis of variance (ANOVA). RESULTS: The nurses' mean level of global interdependence identity was slightly above the neutral point between extreme national-mindedness and full development of global interdependence identity. The best predictors of worldminded attitudes were immigration, patriotism, and war conceptualized under a global frame of reference. CONCLUSION: Novice nurses did not demonstrate an optimum developmental status of global interdependence identity to safeguard cross-cultural encounters with patients. The recommendation is the inclusion of immigration, patriotism, and war in the nursing curriculum and co-curriculum to promote student development and a turnaround improvement in patient experience.

Treatment of co-morbid mental illness in primary care: how to minimize weight gain, diabetes, and metabolic syndrome.

In patients with mental illness the increased risk from cardiovascular disease appears to be related to the increased incidence of obesity, hypertension, and diabetes mellitus. Barriers to the medical care in this patient population include diminished adherence to treatment and preventative recommendations, lack of willingness to engage in self-care activities, decreased access to affordable medical care, underestimation of risk by physicians, and adverse effects of commonly prescribed psychiatric medications. When managing patients with mental illness it is necessary to estimate the patient's metabolic and cardiovascular risk, monitor BMI, waist circumference, fasting glucose, and lipid profile regularly, evaluate psychiatric medications metabolic risk, and choose less "metabolically threatening" drugs. The promotion of healthy lifestyle choices among persons with serious mental illness is essential not only as part of their recovery, but as an integral part of preventing metabolic changes and weight gain linked to their illness and medication side effects. In patients with mental illness and co-morbid diabetes, metabolic syndrome, and obesity, psychiatrist and primary care clinicians should collaborate to establish a plan for healthy lifestyle habits (diet and activity regimen), encourage weight loss, and follow-up regularly using multispecialty teams to improve management.

Vaginitis.

Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. Diagnosis is commonly made using the Amsel criteria, which include vaginal pH greater than 4.5, positive whiff test, milky discharge, and the presence of clue cells on microscopic examination of vaginal fluid. Oral and topical clindamycin and metronidazole are equally effective at eradicating bacterial vaginosis. Symptoms and signs of trichomoniasis are not specific; diagnosis by microscopy is more reliable. Features of trichomoniasis are trichomonads seen microscopically in saline, more leukocytes than epithelial cells, positive whiff test, and vaginal pH greater than 5.4. Any nitroimidazole drug (e.g., metronidazole) given orally as a single dose or over a longer period resolves 90 percent of trichomoniasis cases. Sex partners should be treated simultaneously. Most patients with vulvovaginal candidiasis are diagnosed by the presence of vulvar inflammation plus vaginal discharge or with microscopic examination of vaginal secretions in 10 percent potassium hydroxide solution. Vaginal pH is usually normal (4.0 to 4.5). Vulvovaginal candidiasis should be treated with one of many topical or oral antifungals, which appear to be equally effective. Rapid point-of-care tests are available to aid in accurate diagnosis of infectious vaginitis. Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. Both systemic and topical estrogen treatments are effective. Allergic and irritant contact forms of vaginitis can also occur.

Bioinformatic and expression analyses of genes mediating zinc homeostasis in Nostoc punctiforme.

Zinc homeostasis was investigated in Nostoc punctiforme. Cell tolerance to Zn(2+) over 14 days showed that ZnCl(2) levels above 22 microM significantly reduced cell viability. After 3 days in 22 microM ZnCl(2), ca. 12% of the Zn(2+) was in an EDTA-resistant component, suggesting an intracellular localization. Zinquin fluorescence was detected within cells exposed to concentrations up to 37 microM relative to 0 microM treatment. Radiolabeled (65)Zn showed Zn(2+) uptake increased over a 3-day period, while efflux occurred more rapidly within a 3-h time period. Four putative genes involved in Zn(2+) uptake and efflux in N. punctiforme were identified: (i) the predicted Co/Zn/Cd cation transporter, putative CDF; (ii) the predicted divalent heavy-metal cation transporter, putative Zip; (iii) the ATPase component and Fe/Zn uptake regulation protein, putative Fur; and (iv) an ABC-type Mn/Zn transport system, putative zinc ZnuC, ZnuABC system component. Quantitative real-time PCR indicated the responsiveness of all four genes to 22 microM ZnCl(2) within 3 h, followed by a reduction to below basal levels after 24 h by putative ZIP, ZnuC, and Fur and a reduction to below basal level after 72 h by putative CDF efflux gene. These results demonstrate differential regulation of zinc transporters over time, indicating a role for them in zinc homeostasis in N. punctiforme.

Evaluation and treatment of bone disease after fragility fracture.

Bone mineral density and other measuring tests are part of the risk assessment of primary and secondary osteoporosis necessary in treating patients after fragility fracture. A better understanding of factors contributing to insufficiency fracture in osteoporotic bone is essential to guide the clinician's intervention in this disease affecting 25 million women in the United States and responsible for an estimated 700,000 vertebral and 300,000 hip fractures every year. Prevention of future fractures by slowing or stopping bone loss, maintaining bone strength, and minimizing or eliminating factors contributing to fractures, through pharmacotherapy, education, and lifestyle changes, can help slow annual health care expenditures for osteoporotic fractures, which now exceed 17 billion dollars, more than for breast and gynecological cancers combined.

Recruiting faculty to perform deliveries in family medicine residencies: results of a residency program survey.

BACKGROUND AND OBJECTIVES: One factor cited for the decline of family physicians delivering babies is a lack of faculty role models during residency training. This study's purpose was to determine how many residency programs experience difficulty recruiting faculty who perform deliveries and whether financial or not financial compensation are associated with recruiting difficulties. METHODS: Using an electronic questionnaire, we surveyed program directors of nonmilitary family medicine residencies in the United States, with a response rate of 60.7%. RESULTS: Among residency programs who tried to recruit faculty with delivery skills, 58% stated that they have difficulties. Two program characteristics were associated with recruitment difficulties: the number of delivery providers among faculty and whether the residency program directors included delivery in their own practices. There were no statistically significant associations between recruiting difficulties and any type of financial reimbursement methods, but nonfinancial incentives were offered more often by programs that had no difficulty recruiting. CONCLUSIONS: More than half of all family medicine residency programs have difficulty recruiting faculty members to provide delivery training. Changing the type of financial compensation for faculty providing maternity care is not likely to assist in recruiting. However, we did find that programs without recruiting difficulties were more likely to offer nonfinancial incentives to faculty members who perform deliveries.

Prevalence of breastfeeding and acculturation in Hispanics: results from NHANES 1999-2000 study.

BACKGROUND: A more current estimate to evaluate ethnic and acculturation differences in breastfeeding is warranted, given the rapid growth of the Hispanic population in the United States and the proliferation of breastfeeding promotion programs. The study objective was to describe current national estimates of the prevalence of breastfeeding and evaluate differences in reasons not to breastfeed by acculturation status. METHODS: Secondary data analysis of the National Health and Nutrition Examination Survey (NHANES) 1999-2000 was performed on a nationally representative sample of non-Hispanic white women born in the U.S. and Hispanic women with at least one live birth. Acculturation status among Hispanics was assessed using a validated language scale, and prevalence of breastfeeding was based on maternal self-report. RESULTS: Prevalence of breastfeeding was higher in less acculturated Hispanic women (59.2%) than high acculturated Hispanic women (33.1%) and white women (45.1%). Less acculturated Hispanic women were more likely to cite their child's physical/medical condition as a reason not to breastfeed (53.1%), whereas whites and more acculturated Hispanics were more likely to cite their child preferred the bottle (57.5% and 49.8%, respectively). A logistic regression analysis revealed no significant differences in likelihood to breastfeed between non-Hispanic whites and Hispanics after controlling for education, age, and income. Higher acculturated women were less likely to breastfeed their children than low acculturated women (95% CI: 0.14-0.40) even after education, age, and income were taken into account. CONCLUSIONS: Acculturation differences in prevalence of breastfeeding and reasons not to breastfeed may be the result of attitudinal changes that occur due to acculturation. Further research into the acculturation process and its impact on breastfeeding may help to prevent the decline in breastfeeding that occurs as mothers become more acculturated. Meanwhile, patient education that addresses women's perceptions of the child's health condition and benefits of breastfeeding would be helpful.

Management of hypertension in older persons.

Antihypertensive therapy has been shown to reduce morbidity and mortality in older patients with elevated systolic or diastolic blood pressures. This benefit appears to persist in patients older than 80 years, but less than one third of older patients have adequate blood pressure control. Systolic blood pressure is the most important predictor of cardiovascular disease. Blood pressure measurement in older persons should include an evaluation for orthostatic hypotension. Low-dose thiazide diuretics remain first-line therapy for older patients. Beta blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium channel blockers are second-line medications that should be selected based on comorbidities and risk factors.