Neurogenic Bowel Dysfunction Over the Course of Multiple Sclerosis: A Review.

Neurogenic bowel dysfunction ranks as one of the most frequent problems experienced by people with multiple sclerosis (MS); it is one of the first symptoms to appear at disease onset and continues throughout the course of the disease. This review, based on literature searches of Medline and PubMed, examines bowel dysfunction causes and cofactors (ie, impaired mobility, fatigue, depression and anxiety, childbirth) that occur over the course of the disease. Coverage includes management of bowel dysfunction with noninvasive methods, including diet and fluid intake, together with pharmacologic treatments for constipation and fecal incontinence as well as more advanced treatments (ie, biofeedback, abdominal massage, transanal irrigation, posterior tibial nerve stimulation), caregiver-provided treatments and extended care facilities. Bowel dysfunction problems and related cofactors impact quality of life throughout the MS disease course, requiring appropriate interventions to improve and/or maintain the quality of life of the individual with MS.

Associations Between Self-Reported Symptoms and Gait Parameters Using In-Home Sensors in Persons With Multiple Sclerosis.

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) is a progressive neurological disorder, characterized by exacerbations and remissions, often resulting in disability affecting multiple neurological functions. The purpose of this article was (1) to describe the frequencies of self-reported symptoms in a natural environment and (2) to determine characteristics and associations between self-reported symptoms and home gait parameters (speed, stride time, and stride length) at baseline and at 3 months in patients with MS. METHODS: Participants completed the self-report MS-Related Symptom Scale to measure symptoms. A three-dimensional depth imaging system (Foresite Healthcare) was used to measure gait parameters in the home environment. RESULTS: These data show significant correlations between the following symptoms: knee locking or collapsing, difficulty sleeping, depression, and anxiety with decreased number of average walks per day; however, the symptoms including trouble-making toilet: day and difficulty in starting urine were positively correlated with average walks per day. The symptom numbness was significantly correlated with decreased speed and decreased stride length. DISCUSSION AND CONCLUSIONS: Our findings suggest that certain groups of symptoms were more frequently reported with certain gait parameters (stride time/speed) in persons with MS. Rehabilitation nurses can provide optimal care to prevent future decline in symptoms and gait.

Forensic Interviews for Child Sexual Abuse Allegations: An Investigation into the Effects of Animal-Assisted Intervention on Stress Biomarkers.

The use of therapy animals during forensic interviews for child sexual abuse allegations is a recommendation by the Therapy Animals Supporting Kids Program to help ease children's discomfort during the forensic interview process. Based on this recommendation, this study incorporated a certified therapy canine into the forensic interview process for child sexual abuse allegations. This study investigated changes in salivary cortisol, immunoglobulin A, blood pressure, and heart rate as a result of forensic interview phenomenon (e.g., outcry) incorporating animal-assisted intervention versus a control condition in children (N = 42) interviewed for alleged child sexual abuse. The results supported significantly greater heart rate values for the control group (n = 23) who experienced sexual contact and/or indecency than the experience of aggravated sexual assault compared to no difference in HR for the intervention group (n = 19). The results suggest that the presence of the canine in the forensic interview may have acted as a buffer or safeguard for the children when disclosing details of sexual abuse. In the intervention group, children's HR was lower at the start of the forensic interview compared to the control group. Finding an effect of having a certified handler-canine team available during the forensic interview on physiological measures of stress has real-world value for children, child welfare personnel, and clinical therapists. It is suggested that animal-assisted intervention be expanded to children facing other types of trauma and to treatment programs for child survivors of sexual abuse.

Value, challenges, and satisfaction of certification for multiple sclerosis specialists.

BACKGROUND: Specialist certification among interdisciplinary multiple sclerosis (MS) team members provides formal recognition of a specialized body of knowledge felt to be necessary to provide optimal care to individuals and families living with MS. Multiple sclerosis specialist certification (MS Certified Specialist, or MSCS) first became available in 2004 for MS interdisciplinary team members, but prior to the present study had not been evaluated for its perceived value, challenges, and satisfaction. METHODS: A sample consisting of 67 currently certified MS specialists and 20 lapsed-certification MS specialists completed the following instruments: Perceived Value of Certification Tool (PVCT), Perceived Challenges and Barriers to Certification Scale (PCBCS), Overall Satisfaction with Certification Scale, and a demographic data form. RESULTS: Satisfactory reliability was shown for the total scale and four factored subscales of the PVCT and for two of the three factored PCBCS subscales. Currently certified MS specialists perceived significantly greater value and satisfaction than lapsed-certification MS specialists in terms of employer and peer recognition, validation of MS knowledge, and empowering MS patients. Lapsed-certification MS specialists reported increased confidence and caring for MS patients using evidence-based practice. Both currently certified and lapsed-certification groups reported dissatisfaction with MSCS recognition and pay/salary rewards. CONCLUSIONS: The results of this study can be used in efforts to encourage initial certification and recertification of interdisciplinary MS team members.

Situational factors related to loneliness and loss over time among older pet owners.

Loneliness occurs in people of all ages but can be particularly debilitating in older adults. In this population, there are many factors that enter into the loneliness-loss pathway. The purpose of this study was to examine the interrelations of situational factors, coping, and pet attachment that affect loneliness in 191 older adults who experienced loss over time. Data showed that loneliness was lower among study participants who lived in 55 and over residences than private residences, those who experienced loneliness due to loss, those who reported lower coping, and those who reported higher pet attachment. The results of this study suggest that nurses working with this population need to evaluate loneliness by means of situational factors such as living arrangements. Nurses should also examine the effects of loss over time and discuss coping mechanisms, including the benefit of pet relationships in this vulnerable population. Implications for nursing are addressed.

Factors related to type of companion pet owned by older women.

Although pets can be valuable companions for older adults, little is known about why older adults select a specific kind of pet. This study examined demographic (e.g., marital status, health status), health (i.e., well-being, loneliness), and environmental characteristics (i.e., living arrangement, type of housing) of 159 older women in terms of whether they had a companion dog or cat. Significantly more women who were married/partnered had dogs, whereas more single women had cats. Significantly more women who lived alone had cats, whereas more women who lived with someone had dogs. Women with companion dogs had significantly lower depressed mood and higher levels of general health, vitality, and total well-being than those with cats. Although loneliness was somewhat greater among women with cats, the difference was not statistically significant. More women living in 55-and-older communities had cats, whereas more women living in private homes had dogs. Practicing psychiatric nurses can use the information generated from this research to advocate for pet companionship in order to enhance well-being in older women.

Anorectal dysfunction in multiple sclerosis: a systematic review.

Constipation and fecal incontinence are common in patients with neuromuscular diseases. Despite their high prevalence and potential impact on overall quality of life, few studies have addressed anorectal dysfunction in patients with multiple sclerosis (MS). The goal of this paper is to define the prevalence, pathophysiology, impact, and potential treatment of constipation and incontinence in MS patients. Methods. The PubMed database was searched for English language publications between January 1973 and December 2011. Articles were reviewed to assess the definition of the study population, duration, type and severity of MS, sex distribution, prevalence, impact, results of physiologic testing, and treatments. Results. The reported prevalence of constipation and fecal incontinence ranged around 40%. Anorectal dysfunction significantly affected patients with nearly 1 in 6 patients limiting social activities or even quitting work due to symptoms. Caregivers listed toileting as a common and significant burden. The only randomized controlled trial showed a marginal improvement of constipation with abdominal massage. All other reports lacked control interventions and only demonstrated improvement in individuals with milder symptoms. Conclusion. Anorectal dysfunction is a common manifestation in MS that significantly affects quality of life. Therapies are at best moderately effective and often cumbersome, highlighting the need for simple and more helpful interventions.

Updated research priorities for neuroscience nursing.

In 2007, the Neuroscience Nursing Foundation (NNF) convened a research panel to update NNF's research priorities used to guide funding. The research panel identified leaders in neuroscience nursing and conducted a review of neuroscience nursing research literature and an American Association of Neuroscience Nurses membership survey on research priorities. A workgroup of leaders in neuroscience nursing was then convened to draft and set priorities on the basis of the review of the literature and the membership survey. The updated priorities were submitted to the NNF Board of Trustees for approval. The revised document reviews the mission of NNF and outlines six strategies and five program areas (including specific subareas) that represent priorities for NNF research funding. The purpose of the updated priority document is to provide guidelines for the systematic development of knowledge in neuroscience nursing through the encouragement of selected neuroscience nursing research activities.

Bowel management related quality of life in people with multiple sclerosis: psychometric evaluation of the QoL-BM measure.

BACKGROUND: Bowel dysfunction affects quality of life (QoL) of multiple sclerosis (MS) patients. Existing QoL measures specific to MS disease contain little or no assessment of bowel dysfunction. The Quality of Life Scoring Tool Relating to Bowel Management (QoL-BM) developed for spinal cord injured patients may be relevant for MS patients. OBJECTIVE: Determine reliability and validity of the QoL-BM scale with MS patients. METHOD: The North American Research Committee on Multiple Sclerosis randomly selected 700 MS patients from their registry resulting in 502 respondents who completed the QoL-BM scale, Bowel Function Questionnaire for MS persons (Constipation, Fecal Incontinence, both Constipation and Fecal Incontinence), Patient Derived Disease Steps (mild, moderate, severe disability), MS classification (Relapsing-Remitting MS, Secondary Progressive MS), and demographic sheet. RESULTS: Factor analysis of the QoL-BM scale resulted in two subscales: Management and Relationships. Reliability coefficients for total and subscales were: .90, .86, and .83, respectively. Known-group validity was demonstrated as QoL-BM total scale and subscale scores differed significantly according to type of bowel dysfunction and disability level. CONCLUSION: The QoL-BM scale provides information on current bowel status and its impact on QoL for MS patients.

Monitoring my multiple sclerosis: a patient-administered health-assessment scale.

Optimal health of people with multiple sclerosis (MS) can be promoted by patients' sharing of health information gained through periodic self-monitoring with their health-care providers. The purpose of this study was to develop a valid and reliable self-administered scale to obtain information about MS patients' health status and the impact of the disease on their daily lives. We named this scale "Monitoring My Multiple Sclerosis" (MMMS). A cross-sectional survey was conducted of 171 MS patients who completed the MMMS and Patient-Determined Disease Steps (PDDS) scales and provided information on their MS disease classification and demographic characteristics. Data analysis included several parametric procedures. Factor analysis of the 26-item MMMS resulted in four factors with satisfactory α reliability coefficients for the total scale (0.90) and factored subscales: Physical (0.85), Relationships (0.80), Energy (0.70), and Cognitive/Mental (0.67). Analysis of variance demonstrated that the total scale and the Physical subscale, but not the Relationships subscale, showed significantly worse functioning for patients with either moderate or severe disability as measured by the PDDS than for patients with mild disability (P < .001). The Cognitive/Mental subscale showed significantly worse functioning for patients with moderate disability than for patients with mild disability (P < .05). However, the Energy subscale showed significantly worse functioning among moderately disabled patients than among severely disabled patients (P < .01). Independent t tests demonstrated that patients classified as having secondary progressive multiple sclerosis had significantly worse scores on the total MMMS (P < .05) and the Physical subscale (P < .001) than those classified as having relapsing-remitting multiple sclerosis. The MMMS demonstrated satisfactory reliability and validity and is recommended for use by MS patients and their health-care providers as a mechanism to promote the sharing of health information, to the benefit of both patients and providers.

Cross-cultural validation of a smoking abstinence self-efficacy scale in Korean American men.

The main purpose of the study was to examine the psychometric properties of a Smoking Abstinence Self-Efficacy Scale with Korean men in the US. The scale was modified to reflect the Korean cultural practice of smoking behavior and was cross-culturally validated with a panel of 10 professionals. An 11-item Korean version of the scale was administered twice over a one-month period. Data were analyzed for internal consistency reliability, stability, and construct validity. After the deletion of one item, an exploratory factor analysis yielded two factors, which explained 62% of the variance. Internal consistency was satisfactory for the total scale (.89), Factor I (.88), and Factor II (.80) but intraclass correlation coefficient for the total scale (.57) was low. Nicotine dependence and nicotine withdrawal showed modest but statistically significant correlations with the scale.

Reliability and validity of the Sexual Pressure Scale for Women-Revised.

Sexual pressure among young urban women represents adherence to gender stereotypical expectations to engage in sex. Revision of the original five-factor Sexual Pressure Scale was undertaken in two studies to improve reliabilities in two of the five factors. In Study 1 the reliability of the Sexual Pressure Scale for Women-Revised (SPSW-R) was tested, and principal components analysis was performed in a sample of 325 young, urban women. A parsimonious 18-item, four-factor model explained 61% of the variance. In Study 2 the theory underlying sexual pressure was supported by confirmatory factor analysis using structural equation modeling in a sample of 181 women. Reliabilities of the SPSW-R total and subscales were very satisfactory, suggesting it may be used in intervention research.

Psychometric properties of the alcohol use disorders identification test: a Korean version.

OBJECTIVE: The Alcohol Use Disorders Identification Test (AUDIT) is an important screening tool but has never been administered to Korean Americans. This study was conducted to examine the psychometric properties of a Korean version of the AUDIT referred to as AUDIT-K and to determine which cutoff score of the scale would perform better in Korean Americans. METHOD: Translation and backtranslation of the AUDIT-K were conducted to obtain a measure consistent with the Korean cultural understanding of alcohol use. Following satisfactory interrater agreements on each item about its Korean translation, the AUDIT-K was administered to 118 Korean American men (Time 1) and to 93 of the men approximately 1 month later (Time 2). Data were analyzed for internal consistency reliability, test-retest reliability, and construct validity. RESULTS: Approximately 47.5% of Korean American men who participated in the study were identified as having drinking problems when using the World Health Organization's recommended cutoff score of 8, whereas approximately 20.3% were found to have problems with alcohol when using the cutoff score of 12, the one recommended for Koreans. Cronbach's alpha was .82 at Time 1 and was .80 at Time 2. Test-Retest reliability assessed via the intraclass correlation coefficient for the total AUDIT scale was .85. Principal components factor analysis with varimax orthogonal rotation revealed a two-factor solution, alcohol consumption and drinking problems, resulting in 57% of the explained variance. CONCLUSIONS: The AUDIT-K was found to be internally consistent and stable over time and should be used in primary health care settings to screen Korean American men for alcohol use disorders to facilitate early interventions.

Psychometric properties of the Minnesota Nicotine Withdrawal Scale: a Korean version.

Smoking is considerably more common among Korean American male individuals compared with all U.S. males, but no reliable and valid nicotine withdrawal scale has been available to measure withdrawal symptoms from the Korean American perspective, which is the aim of the present study. Translation and back-translation of the Minnesota Nicotine Withdrawal Scale (MNWS) was conducted to obtain a measure consistent with the Korean cultural understanding of smoking withdrawal symptoms. Following satisfactory interrater agreements, the Korean version (MNWS-K) was administered to 118 Korean American male smokers. Data were analyzed for internal consistency reliability and stability as well as construct validity. Internal consistency reliability was satisfactory for the total scale and factors (.88, .88, .79) and intraclass correlation coefficient (ICC) for the total score over a 1-month period was fair (r = .51). Exploratory factor analysis with orthogonal rotation yielded two factors. Together, Factor I, early-occurring disturbances in mental functioning, and Factor II, disturbances in physiological functioning and late-occurring disturbances in mental functioning, explained 66% of the variance in the scale. Theoretically related variables to the MNWS-K, number of smoking quit attempts and self-efficacy, showed modest but statistically significant correlations with the MNWS-K total and factored scales. Satisfactory internal consistency coefficients together with the validity findings suggest the MNWS-K warrants use with the Korean American population.

Job satisfaction among multiple sclerosis certified nurses.

Several studies document high levels of job satisfaction among certified nurses, but no study has examined job satisfaction and factors influencing job satisfaction of certified multiple sclerosis (MS) nurses. This study tested a theoretical model proposing that two organizational factors, colleague relationships and benefits, will predict job satisfaction. Job satisfaction was represented by four factors: autonomy, professional status, professional growth, and time efficiency. Participants included MS nurses certified for 6 months or more practicing mostly in three countries (Canada, Great Britain, and the United States) who anonymously completed the Misener Nurse Practitioner Job Satisfaction Scale, an overall job satisfaction rating, and demographic information. Findings indicate that colleague relationships and benefits significantly estimated organization structure and that autonomy, professional status, professional growth, and time efficiency significantly estimated job satisfaction; furthermore, organization factors such as colleague relationships and benefits significantly predict job satisfaction. Among the countries, several statistically significant differences were observed between job satisfaction factors as well as items in both organization and job satisfaction subscales. Average factor scores among the countries were mostly rated satisfactory. The International Organization of Multiple Sclerosis Nurses Executive Board plans to use the study findings to see how it needs to focus efforts as an organization toward enhancing and standardizing MS care and develop MS nurse professionalism worldwide.

Postpartum functioning in mothers with multiple sclerosis.

Increased family demands during the postpartum period together with having to cope with symptoms and curtailed everyday functioning associated with multiple sclerosis (MS) suggest the need for additional support for mothers with MS throughout the first postpartum year. This study investigated factors (MS duration, MS relapse, symptoms, social support) that affect functional performance of 172 mothers with MS during the second 6-month postpartum period. Data were analyzed with descriptive statistics and path analysis. Findings indicated a good fit of the path models to the data at 9 and 12 months. Significant effects at both 9 and 12 months included positive relationships between duration of MS and symptoms and between social support and functional performance. Significant negative relationships were observed between symptoms and both social support and functional performance. Social support mediated the relationship between symptoms and functional performance. Findings suggest the importance of continued social support throughout the first postpartum year.

Postpartum emotional distress in mothers with multiple sclerosis.

OBJECTIVE: To determine the impact of multiple sclerosis (MS)-related symptoms and both received social support and perceived deficits in social support on emotional distress in mothers with MS at 1, 3, and 6 months postpartum. DESIGN: Longitudinal correlation descriptive study. SETTING: Community-residing women in North America. PARTICIPANTS: Convenience sample of 174 postpartum mothers with MS. METHOD: Mothers completed the MS-Related Symptom Scale and Postpartum Support Questionnaire at 1, 3, and 6 months postpartum. Bivariate correlations and hierarchical regression analyses determined relationships between the dependent variable, emotional distress, and independent variables: participant characteristics, MS-related symptoms, and social support. RESULTS: The authors found moderately strong positive correlations between MS-related symptoms and emotional distress at each assessment. Significant negative correlations existed between received social support and emotional distress at 1 month but not at 3 and 6 months. Significant positive correlations existed between MS-related symptoms and social support deficits at each assessment. Explained variance in emotional distress across the three assessments ranged between 2% and 4% for participant characteristics, 49% and 60% for MS-related symptoms, 2% and 7% for social support, and 57% and 66% for total variance. CONCLUSION: MS-related symptoms created considerable emotional distress in mothers that was minimally alleviated by the support given them. In fact, many needed more support than they received.

Infant health of mothers with multiple sclerosis.

Controversy surrounds whether mothers with multiple sclerosis (MS) who wish to breast-feed their infants should forego breast-feeding in order to resume immunomodulating therapy following birth even though breast-feeding has not been shown to have deleterious effects on these mothers. Knowledge of potential health benefits to infants through breast-feeding could influence health care providers to encourage mothers with MS who wish to breast-feed to do so. This study of 140 breast-feeding and 35 non-breast-feeding mothers with MS identifies the type and prevalence of illnesses experienced by their infants during the first 6 postpartum months and at 9 months and 12 months. Significantly more non-breast-fed than breast-fed infants experienced otitis media, lower respiratory illness, constipation, milk intolerance, and allergy during the 1st year. Study results support the need to encourage mothers with MS who wish to breast-feed their infants to do so and to delay immunomodulating therapy until breast-feeding cessation.

Adaptation of the postpartum support questionnaire for mothers with multiple sclerosis.

The purposes of this study were to determine the dimensionality of the Postpartum Support Questionnaire adapted for mothers with multiple sclerosis through factor-analytic techniques and to provide construct validity for the factored dimensions. One hundred and seventy-four mothers with multiple sclerosis comprised the sample. Using a priori criteria, a three-factor structure, resulting from principal components analysis with an orthogonal rotation consisting of 24 of the 28 items, was found to best represent the dimensionality of the instrument. The three support factors-emotional, instrumental, and informational-showed acceptable coefficient alpha reliabilities at the 1-, 3-, and 6-month administrations. Evidence of construct validity was shown in that, as hypothesized, (a) mothers with comparatively lower emotional distress reported higher levels of emotional and instrumental support, and (b) mothers with one child reported receiving more informational support during the 6-month postpartum period than did mothers with more than one child. The results support the use of the 24-item Postpartum Support Questionnaire in assessing the adequacy of these specific dimensions of social support needed by mothers with multiple sclerosis during the postpartum period.