Educational needs and altered eating habits following a total laryngectomy.

PURPOSE/OBJECTIVES: To describe eating-related experiences and informational needs of people following total laryngectomies. DESIGN: Descriptive study. SETTING: Internet-based laryngectomy support group in the United States. SAMPLE: 34 people with a laryngectomy (68% total laryngectomy, 29% with total plus radical neck dissection, and 3% with partial laryngectomy with radical neck dissection): 29 males, 5 females; mean age of 62 years. METHODS: Members of a laryngectomy support group completed a Food Eating Experiences and Diet Questionnaire designed by the investigators. Both quantitative and qualitative data were collected. MAIN RESEARCH VARIABLES: Effect of laryngectomy on food choice, eating habits, and overall enjoyment of eating: perceptions of teaching received from healthcare professionals regarding potential eating difficulties as a result of laryngectomy. FINDINGS: 90% of the participants experienced a change in one or more aspects of eating. The most prominent changes were decreased sense of smell, decreased taste, decreased enjoyment of eating, and an increase in the length of time required to eat meals. Most participants were not satisfied with the information they received from healthcare professionals. Topics requiring emphasis during patient teaching were identified from participants' comments. CONCLUSIONS: Total laryngectomy produced significant changes in factors related to eating that can affect nutritional intake and quality of life. Participants reported that most healthcare providers did not adequately prepare them for potential alterations in eating that can occur following a total laryngectomy. IMPLICATIONS FOR NURSING PRACTICE: Data from this study can be used to raise awareness of incidence and severity of changes in eating that occur after total laryngectomy and to improve patient preparation to cope with these changes.

Differences between men and women in anxiety early after acute myocardial infarction.

BACKGROUND: Anxiety after acute myocardial infarction influences both short- and long-term recovery. Therefore, determining specific subgroups of patients who have relatively higher anxiety levels is important. Published findings about gender differences in anxiety after acute myocardial infarction are conflicting. OBJECTIVES: To determine whether gender differences in anxiety after acute myocardial infarction exist and whether any of the sociodemographic and clinical variables that often differ between men and women with acute myocardial infarction interact with gender to influence anxiety. METHODS: A total of 424 patients with confirmed acute myocardial infarction were enrolled in this multicenter prospective study. Patients' anxiety level was measured within 72 hours of their arrival at the hospital by using the State Anxiety Inventory and the Brief Symptom Inventory. RESULTS: Women had significantly higher anxiety than did men according to both the State Anxiety Inventory (42 +/- 12.9 vs 37.7 +/- 12.5; P = .001) and the Brief Symptom Inventory (0.83 +/- 0.97 vs 0.63 +/- 0.71; P = .02). Of the sociodemographic and clinical variables examined, only marital status and income significantly interacted with gender to influence anxiety. Married women had higher anxiety than did single and widowed women, and married men had lower anxiety than did single men. Women with lower income had higher anxiety than did women with higher income; income was not related to anxiety in men. CONCLUSION: Women report significantly greater anxiety early after acute myocardial infarction than men do. Women's greater anxiety may be partially explained by marital status and lower income at the time of the infarction.

Self-reported weapon ownership, use, and violence experience among clients accessing an inner-city sexually transmitted disease clinic.

Little is known about the extent to which people who access public health care settings own/carry weapons and experience/perpetrate acts of violence. The purpose of this study was to describe weapon ownership and violence experiences of persons attending an inner-city sexually transmitted disease clinic. Face-to-face interviews were administered to 245 clients to assess weapon ownership, types of weapons carried, and experiences as victims or perpetrators of violent acts. Overall, 43.7% reported experience of carrying a weapon at some point in their lives. More men chose to carry guns; more women chose to carry knives or mace. Participants reported experiencing alarming levels of violence in the previous year: 30.5% experienced beatings, 23.9% reported being threatened with a gun, and 18.9% reported forced, unwanted sex. Persons with a history of carrying weapons were significantly more likely to report being both victims and perpetrators of violence. Persons who experienced violence in the previous month were significantly more likely to be diagnosed with an STD. Results show that STD clinics represent yet another setting wherein interventions to curb the extent of violence might be appropriate, and strategies to assist and protect those experiencing violence are needed.

The development of sexual risk taking in adolescence.

This chapter reviews literature from 1985 to the present that is focused on the development of sexual behaviors in adolescents, decision making about sexual behavior, and sexual risk-taking behaviors. Results show that sexual behavior is part of most people's lives from childhood through adulthood, and that the majority of adolescents begin to engage in sexual behaviors in their teenage years. Synthesis of this large body of research reveals a lack of theoretical frameworks to guide research in sexual risk taking, resulting in an incomplete understanding of the predictors of sexual risk-taking behavior in adolescents. New and broader approaches in the study of sexual risk taking are needed that include consideration of the social and developmental context from which adolescents make decisions about sexual behavior.

Reasons for not using condoms of clients at urban sexually transmitted diseases clinics.

BACKGROUND AND GOAL: Greater understanding of the factors related to inconsistent condom use is essential in the development of strategies to promote condom use among clients who access public, inner-city sexually transmitted diseases (STD) clinics. Therefore, this study aimed to explore reasons for not using condoms among 260 predominantly African American heterosexual male and female clients presenting for care at two inner-city STD clinics. STUDY DESIGN: Clients selected for this descriptive analysis reported having had at least one unprotected episode of sexual intercourse in the last 10 episodes. In face-to-face interviews, clients provided information about sexual activity, sexual partners, and condom use in the previous 30 days. In addition, they were asked to indicate the main reason for not using condoms when having unprotected sex. RESULTS: Content analysis showed six major categories of reasons for not using condoms: reasons related to partner relationships, reasons related to sexual sensation, reasons related to situational constraint, reasons related to condoms themselves, reasons related to pregnancy, and reasons related to types of sexual activity. Most frequent explanations given for not using condoms included partner trust (19.6%), the feel of condoms (11.9%), and lack of condom availability (11.5%). Clients also reported barriers to condom use that included beliefs about condom sensation and partner relationships. CONCLUSIONS: These results show the continued barriers that exist with respect to condom use in at-risk populations and emphasize the need to tailor meaningful interventions in order to promote condom use among persons who, for differing reasons, choose not to use them.

Gender and knowledge about HIV, risky sexual behavior, and safer sex practices.

The purpose of this study was to examine gender differences in knowledge about HIV, the reported incidence of risky sexual behavior, and comfort with safer sexual practices among young adults. The conceptual framework was social role theory, which argues for the influence of gender roles on beliefs and social behaviors. Participants were 141 female and 131 male college students who responded to questions regarding their knowledge of HIV, risk-taking behaviors with respect to HIV, and comfort with safer sexual behaviors. Overall, respondents had accurate knowledge about HIV. However, men reported engaging in significantly more risky behaviors than women. More men reported that intercourse without a condom occurred in unplanned, spontaneous situations, while under the influence of alcohol or drugs, or with a person not well known. More women reported that intercourse without a condom occurred in long-term relationships. Women were significantly more comfortable abstaining from sexual intercourse and asking partners about their sexual history while men were significantly more comfortable buying condoms. Both men and women reported comfort using condoms. Gender roles help to explain why men are willing to take more risks, and in what situations risk taking is apt to occur.

Moral reasoning about sexually transmitted diseases.

The purpose of this research was to investigate moral reasoning related to sexual behavior that could lead to the transmission of sexually transmitted diseases (STDs). Using hypothetical dilemmas about situations in which STDs can be transmitted, respondents were asked to explain why they believed the characters should or should not engage in risky behaviors. 40 college freshmen (M = 18.3 years) and 32 college seniors (M = 22.3 years) participated. Using Kohlberg's moral stage theory and Gilligan's moral orientation model, the interviews were scored for moral stage and moral orientation. Results indicated that the older age group had a significantly higher stage of moral reasoning than the younger age group when responding to dilemmas about STDs. There was a significant difference in moral stage between dilemmas, reflecting the possible effect of dilemma content on moral reasoning. The overall pattern of results shows nonsignificant gender differences in stage of moral reasoning and moral orientation. Clinical and theoretical implications of these findings for understanding the role of moral reasoning in sexual risky behavior are discussed.

Perceived stressors and coping responses in persons with recurrent genital herpes.

This descriptive study was designed to examine the disease experience of persons who have genital herpes by identifying the nature and frequency of disease-related stressors and coping responses associated with these stressors. Participants were 34 women and 26 men who were on average 5.3 years postdiagnosis, and experienced a mean of 6.4 recurrences per year. Respondents reported a wide range of disease-related stressors (M = 7). The category of stressors identified most often was related to disease consequences (73.9%), and included difficulty with intimate relationships, difficulty with relationships involving family and friends, fear of transmission through both sexual activity and casual contact, and concern about negative effect on health. Respondents tended to use active coping, planning, and acceptance more often than passive strategies such as denial. Implications for clinical assessment and intervention are discussed.