Defining and measuring fatigue.

In response to a long history of problems with defining and measuring fatigue, the University of Kansas School of Nursing established a Center for Biobehavioral Studies of Fatigue Management to facilitate the study of fatigue in diverse populations. The purpose of this article is to review past efforts to define and measure fatigue and the conceptual problems relevant to currently used measures of fatigue. Several distinct characteristics and corresponding measures of fatigue are identified and a definition and framework for the study of fatigue are discussed. Future research on fatigue must attend to the conceptual distinctions among various measures and the measures of fatigue most appropriate to the goals of a study.

Balancing ethical quandaries with scientific rigor: Part 2.

Traditional ethical concerns in research tend to focus on serious misconduct such as fabricating data and gross violations of informed consent. In this two-part article, we focused on some of the less serious and more subtle ethical quandaries, inherent and common in most social science research. It is our thesis that these issues are important and warrant more attention and careful thought than they have been accorded in the scientific literature and, perhaps, by investigators at large. In Part 2, we provided examples of how we, and others, dealt with some of these issues in actual studies. However, we also must emphasize the individual and reflective nature of confronting ethical issues in research. We found many benefits in using a team approach to address ethical dilemmas during implementation of our studies. Doing so kept everyone honest with themselves and each other, shared the burden of responsibility among team members for the decisions made, maximized the use of team members' strengths, and led to much better resolutions of the issues from both a scientific and an ethical perspective. Maintaining scientific rigor while balancing and deliberating about the ethical implications of decisions is a challenge for all research teams. It requires learning how to be vigilant and responsive when faced with the many subtle, but ever-present, scientific and ethical quandaries encountered when doing what is often assumed to be nonthreatening social research. There are no fixed, prescriptive rules for what to do in every study. Rather, a reflective process, considering the specific issues of each unique study, is required.

Intensive nutrition counseling enhances outcomes of National Cholesterol Education Program dietary therapy.

OBJECTIVE: To compare the effect of the addition of medical nutrition therapy administered by a registered dietitian with the usual physician counseling on nutrition knowledge, attitudes regarding dietary change, body mass index, dietary intake, and lipid and lipoprotein concentrations during initial management of persons at risk for cardiovascular disease. DESIGN: A 3-month prospective, randomized trial of subjects stratified by sex and assigned to one of four nested treatment groups, which were subsequently collapsed into two groups. SUBJECTS: Fifty-two men and 52 women classified at risk for cardiovascular disease. INTERVENTION: Two groups of subjects received dietary counseling from a physician or nurse; in one group the Grocery Shopping Guide was used. Two other groups received medical nutrition therapy from a registered dietitian (one or three visits) in addition to the instruction from a physician or nurse and the information provided by the Grocery Shopping Guide. STATISTICAL ANALYSES: Analyses of covariance were performed to determine differences between the groups. Paired t tests were performed to study changes within the groups. RESULTS: The group receiving medical nutrition therapy from a registered dietitian gained statistically significantly more nutrition knowledge; had significantly greater perceptions of the benefits and efficacy of following a cholesterol-lowering diet; consumed a significantly lower percentage of fat, higher percentage of carbohydrate, and less dietary cholesterol than subjects counseled only by a physician or nurse. They also had significantly greater improvement in body mass index. Both groups of subjects achieved statistically significant reductions in serum lipid levels. APPLICATIONS: Increased knowledge, benefits, and efficacy and lower-fat eating behaviors associated with additional nutrition therapy may have significant implications on the ability of persons to follow low-fat eating plans long term, which could reduce the need for costly medication intervention.

Use of health records in research: reliability and validity issues.

Data extracted from health records are commonly used in studies to address a variety of questions raised by health researchers. However, concern about the reliability and validity of such data generally is limited to an assessment of interrater reliability. Less attention has been paid to the reliability of the health record itself, and to the validity of both the health record and the data extracted from it. This article reviews the distinctions and overlaps among these types of reliability and validity and the factors that influence the validity and reliability of research data obtained from health records. Recommendations to investigators who use health record data in their research projects are offered.

The relationship between weight gain and nutrition in pregnancy.

Balanced nutrition and weight gain during pregnancy, and the relationship between these variables and pregnancy outcomes were examined. Data were collected from 510 pregnant women and from their prenatal, hospital, and infants' health records. Despite a common assumption in the prenatal literature that weight gain during pregnancy reflects nutritional adequacy, nutrition and weight gain were only weakly related in this sample. Further, nutritional balance did not significantly contribute to additional explained variance in mother's weight gain when gestation, body mass index, and edema were controlled. Moreover, it was weight gain, not nutrition, that contributed to variance in baby's birth weight. These results suggest that while weight gain during pregnancy influences fetal outcomes, weight gain may not be a valid measure of nutrition.

Tobacco, alcohol, and caffeine use during pregnancy.

Research on the effects of smoking, alcohol, and caffeine on the outcomes of pregnancy is reviewed. The strength of the evidence on the effects of these substances is varied, ranging from some clear and consistent findings for smoking to inconsistent findings for caffeine. Evidence regarding alcohol is strong in some areas and less consistent in others. The implications for clinical practice, particularly that effects vary with both the timing and the amount of the substances used, are discussed.

Perceived and received support: effects on health behavior during pregnancy.

The effects of several measures of social support on three health behavior practices during pregnancy--abstinence from alcohol, cigarettes, and caffeine--were explored. Both specificity of support and the distinction between perceived and received support were examined. The sample consisted of 529 pregnant women who completed written questionnaires and telephone interviews. Analyses showed that specific perceived and received support were significant and largely independent predictors of all three behaviors. General social support, however, was not a significant predictor of any of the behaviors. Although others have found perceived support rather than received support to be the critical component of social support in its stress-buffering effects on health, this study offers evidence that received support is also important for facilitating positive health behaviors.

Seeking information: where do pregnant women go?

As part of a larger investigation of health behaviors and beliefs during pregnancy, a sample of 529 women were asked to identify their major sources of information about what they should and should not do during their pregnancies. Health care providers and books were cited as first or second most important by the largest number of respondents. When associations between respondent characteristics and preferred information sources were explored, it was found that women of higher socioeconomic status (SES) relied more on books and less on family than did women of lower SES. In addition, having had a previous pregnancy was associated with greater use of one's self as an information source. Although provider characteristics were not associated with choice of information source, women who perceived more support from their providers viewed them as more important sources of information. A similar effect for family was found. Health locus of control beliefs also were related to the relative importance of selected sources of information, while general social support was not.

Nurse-midwives and obstetricians: alternative models of care and client "fit".

Issues related to the fit between clients and providers were investigated using data on 244 women who received prenatal care at one of two health care facilities that offered both nurse-midwifery and obstetrician services. Characteristics of the women who received each type of care, as well as their perceptions of their health provider, were explored. No significant demographic differences were found between the nurse-midwifery (CNM) and obstetrician (OB) client groups. The CNM clients scored higher on internal locus of control and the OB clients scored higher on chance and powerful others locus of control. For five of six behaviors (prenatal care, diet, exercise, and abstaining from caffeine and alcohol), the CNM clients consistently viewed their providers as holding significantly stronger attitudes about the behavior and as being significantly more supportive of their engaging in them than did the OB clients. Findings from this study provide evidence in support of offering women alternatives in maternity care.