Postural balance in young adults: the role of visual, vestibular and somatosensory systems.

PURPOSE: The purpose of the study is to examine what sensory system predominates to maintain balance (e.g., visual, vestibular, and somatosensory) among people in their twenties and thirties. DATA SOURCES: A subset of individuals from a larger descriptive cross-sectional study was assessed. A sample of 194 (males = 28%, females = 72%) young adults in the second and third decades of life had anthropometric measurements (height, weight, waist circumference, hip circumference, and leg length) taken and body mass index and waist-to-hip ratio were calculated. Balance was assessed using the NeuroCom Balance Master machine. RESULTS: There was a significant difference among the three sensory systems for postural balance among the young population, F (2, 576) = 111.741, p < .001. Post hoc Bonferroni tests were maintained at the 0.05 level which showed significance for the visual system compared to vestibular and somatosensory system: visual (M = 93.7, SD = 2.07); vestibular (M = 90.4, SD = 2.74); and somatosensory (M = 90.0, SD = 3.13). Based on the results, the visual system is the predominant sensory system used by young adults to maintained optimal postural balance. SIGNIFICANCE FOR PRACTICE: There is very little known about balance of younger adults. If balance issues are identified early in adult life it is possible to prevent exacerbation of balance decline as one age. If nurse practitioners are aware of what dominant sensory systems for balance young adults use, perhaps strategies to preserve these can avoid falls as they age.

Getting it right: optimizing transfusion management during the procedure.

There is little doubt that blood transfusions have saved many lives in cases of acute hypovolemia and anemia, but both the literature and practitioners still do not agree as to what the appropriate indicators for transfusion are in a cardiac surgical patient. Furthermore, there are those who claim that the benefit of blood transfusions has never been conclusively demonstrated, and evidence of transfusion related harm continues to accumulate. Cardiac surgical patients may be transfused not only because of bleeding but also due to hemodilution from preoperative and intraoperative intravenous fluids and pump primes in conjunction with a possible preoperative anemia. Getting transfusion right to improve our practice has to be approached multifactorially. The use of prophylactic dosing of blood products has been suggested to be ineffective in reducing blood loss. There are many factors that impact transfusion rates including determining the optimal hematocrit where it is highly unlikely that one figure will be applicable to all patients. The formulation of transfusion guidelines and algorithms that have been agreed upon by all practitioners involved in the care of cardiac surgical patients may have a positive effect-if everyone agrees to transfuse patients via the formulated guidelines or algorithms. Importantly, no one individual should be able make the decision on whether a patient requires a blood transfusion-it must at all times be a team decision, whether in the operating room or intensive care unit.

Knowledge of AIDS, perceived risk of AIDS, and at-risk sexual behaviors among older adults.

PURPOSE: To identify older adults' knowledge of acquired immune deficiency syndrome (AIDS), perceptions of their risk of AIDS, and at-risk behaviors by using a questionnaire derived from the health belief model. DATA SOURCES: A descriptive correlation design was used to survey persons 50 years of age and older who participate in university-based senior programs. The sample of 166 persons (55% return rate) had a mean age of 71 years and included 33% males. The sample is representative of the participants in these programs. CONCLUSIONS: Five hypotheses based on the health belief model were tested. Statistical analyses showed significant predictors of the likelihood of using recommended safe sexual practices were gender, knowledge of AIDS, perceived susceptibility to AIDS, and perceived threat of AIDS. The results indicated the respondents were knowledgeable about human immunodeficiency virus (HIV) transmission through casual contact and medical aspects of AIDS. Although the respondents recognized the seriousness of AIDS, they generally did not believe that they were susceptible to this disease, even though about 10% indicated sexual activity outside of a long-term relationship. IMPLICATIONS FOR PRACTICE: The study findings support the need for nurse practitioners to assess sexual behaviors in and provide information about safe sex practices to older clients because of the documented rising incidence of AIDS in persons over 50 years of age.

Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being.

This study measured the responses of 17 cancer hospice patients to humidified essential lavender oil aromatherapy. Vital signs as well as levels of pain, anxiety, depression, and sense of well-being were measured (using 11-point verbal analogs). Each subject was measured on three different days before and after a 60-minute session consisting of (1) no treatment (control); (2) water humidification (control); or (3) 3-percent lavender aromatherapy. Results reflected a positive, yet small, change in blood pressure and pulse, pain, anxiety, depression, and sense of well-being after both the humidified water treatment and the lavender treatment. Following the control session (no treatment), there was also slight improvement in vital signs, depression, and sense of well-being, but not in pain or anxiety levels.

Exploring the association between body weight, stigma of obesity, and health care avoidance.

PURPOSE: To explore the stigma of obesity and its effect on health care utilization, associations between self-esteem, attribution for weight, body mass index (BMI), satisfaction with medical care and the behavior of delaying/avoiding health care were examined. DATA SOURCES: A convenience sample of 216 women recruited from church sites in Las Vegas completed self-administered questionnaires. CONCLUSIONS: The findings show an increase in BMI is associated with an increase in the delay/avoidance of health care. Weight-related reasons for delaying/avoiding health care included having "gained weight since last health care visit," not wanting to "get weighted on the provider's scale," and knowing they would be told to "lose weight." IMPLICATIONS FOR PRACTICE: The obese are a stigmatized and vulnerable population. Nurse practitioners are challenged to be aware of attitudes towards obesity and to identify ways to promote continuity of care and regular health maintenance. The goals of Healthy People 2010 to reduce obesity-related morbidity cannot be met if health care is delayed/avoided.