The effect of environmental tobacco smoke exposure on allergic sensitization and allergic rhinitis in adults.

BACKGROUND: There is only little and furthermore conflicting knowledge about the relationship between passive smoking and allergy in adults. In this work, we assess the association between exposure to environmental tobacco smoke (ETS) at home or at work, and allergic sensitization and allergic rhinitis in 4093 German adults. METHODS: Our study population comes from the German National Health Survey 1998 of which we analyzed 4093 adults (17-79 years) being non-smokers and having complete information on passive smoking and allergy. The association between ETS exposure and allergic sensitization and allergic rhinitis was assessed using logistic regression models. RESULTS: The effect of ETS exposure on allergic sensitization was biggest at the workplace [adjusted OR = 1.17 (0.97, 1.41)]; the same could be observed with respect to allergic rhinitis [adjusted OR = 1.20 (0.96, 1.51)]. There was no effect of ETS exposure at home on both allergic sensitization [adjusted OR = 0.99 (0.76, 1.29)] and allergic rhinitis [adjusted OR = 1.05 (0.76, 1.43)] in our analysis. CONCLUSIONS: The findings from our study show a statistically non-significant tendency that exposure to ETS at the workplace increases allergic sensitization and allergic rhinitis in adults. This tendency could not be observed with respect to ETS exposure at home. PRACTICAL IMPLICATIONS: Exposure to ETS at the workplace should be minimized in order to reduce the risk of allergic sensitization, and allergic rhinitis.

Repeated measurements of allergens and endotoxin in settled house dust over a time period of 6 years.

BACKGROUND: Studies investigating the effect of exposure to indoor allergens and endotoxin on human respiratory health usually take dust samples only at one single point of time and consider them to be representative for the indoor biocontaminant burden during a time period of several years. This singly measured biocontaminant concentration is related to adverse respiratory outcomes such as asthma, wheeze or others. OBJECTIVE: We analysed two repeated measurements of mite and cat allergens in mattress and living room floor dust as well as endotoxin concentrations in living room floor dust. The repeated samples were taken over a time period of about 6 years. We investigated the repeatability over time of their concentrations by determining correlation coefficients and computing within- and between-home variance components. METHODS: Our analysis was based on the population of a study on Indoor Factors and Genetics in Asthma (INGA) being carried out in 1995/96 and followed up in 2000/01. Complete data were available from 152 participants. RESULTS: The measured allergen concentrations were low and a considerable percentage of the values was below the limit of detection. The crude Spearman's rank correlation coefficients between the two measurements taken in 1995/96 and 2000/01 ranged from 0.32 to 0.61 for the dust mites allergens, from 0.21 to 0.44 for cat allergen and from 0.35 to 0.51 for endotoxin. Correlations were higher if measurements were performed on the same floor or the same mattress at both sampling time-points. The within-home variance for all measured biocontaminant concentrations was of about the same order as the between-home variance. CONCLUSION: For studies like ours with low allergen and endotoxin concentrations, the repeatability of these concentrations over a time period as long as 6 years is low and a single measurement does not accurately reflect the true long-term exposure in the homes.

Exploring the impact of physician verbal abuse on perioperative nurses.

The purpose of this study is to explore the incidence and impact of physician verbal abuse on perioperative nurses. Roy's Adaptation Model was used as the framework for this descriptive, exploratory study. Seventy-eight perioperative nurses completed the Verbal Abuse Scale questionnaire. Seventy-one nurses (91%) reported experiencing some type of verbal abuse from a physician during the past year. Results show, however, that nurses use adaptive coping behaviors and problem-focused skills to deal with the abuse.

Self-care agency and quality of life among adults diagnosed with inflammatory bowel disease.

Individuals with inflammatory bowel disease (IBD) often exhibit anxiety and depression, pain and reduced energy but may not adequately develop self-care agency (SCA) to manage IBD. The purpose of this study was to examine whether SCA is related to quality of life in adults diagnosed with IBD. The sample of 34 individuals for this descriptive, correlational study completed three questionnaires including the Appraisal of self-care agency scale (A.S.A.-A Scale), the Inflammatory bowel disease questionnaire and a Demographic data questionnaire. Results indicated SCA was unrelated to indicators of quality of life among IBD individuals. This finding may be attributed to the high level of functioning of the sample. However, IBD quality of life (emotional functioning, social functioning, and bowel and systemic symptoms) was negatively correlated with the number of medications individuals took and positively correlated with the number of diagnosed chronic illnesses.

Physical activity research in nursing.

PURPOSE: To present exemplars of physical activity research in nursing, illustrate the importance of physical activity research across the lifespan, and recommend directions for theory development and research. METHODS: Studies of physical activity and exercise currently being conducted by nurse investigators were reported and critiqued by attendees of the Midwest Nursing Research Society 2000 Preconference session entitled "Promoting Physical Activity Among Diverse Groups Across the Health Continuum." Physical activity and exercise literature during the past decade was reviewed. Databases searched included Medline, CINAHL, Wilson, and ERIC. FINDINGS: Investigators have emphasized the need to evaluate the effects of theory-based physical activity interventions designed to alter key correlates of physical activity identified through descriptive research. CONCLUSIONS: Regular physical activity is necessary for health promotion and disease prevention for all populations. Continued research in this important area of health behavior is critical to identify the most effective interventions to increase physical activity among diverse populations.

Variables that discriminate length of stay and readmission within 30 days among heart failure patients.

The purpose of this study was to determine which variables may discriminate between a short length of stay (LOS) and a long LOS and readmission within 30 days among heart failure (HF) patients discharged from a hospital. The charts of 188 patients who were discharged with diagnostic related group 127 during September 30, 1997, until October 31, 1998, were retrospectively reviewed to examine the association between LOS and readmission among 12 variables. It was discovered that an increased number of physicians involved during the patient's hospitalization (p = 0.000) and case management involvement (p = 0.007) were discriminating variables for those patients with a longer LOS. The variables of serum sodium (p = 0.032) and higher NYHA classification (p = 0.018) approached significance in discriminating a longer LOS. HF patients who were readmitted within 30 days were significantlyfound to have an increased NYHA class (p = 0.002) and no specific follow-up plan arranged related to the patients' HF diagnosis (p = 0.005). The results of this study indicate several variables that significantly discriminate LOS and readmission within 30 days among HF patients that case managers can employ to improve care to this population.

Predictors of four functional tasks in patients with osteoarthritis of the knee.

PURPOSE: The purpose of this study was to identify predictors of performance on four functional tasks in adults with osteoarthritis (OA) of the knee. DESIGN: Descriptive correlation. METHODS: A voluntary sample of 78 community dwelling adults who reported knee pain and were previously diagnosed with osteoarthritis of the knee were timed while they performed the functional tasks of going down and getting up off of the floor and ascending and descending a flight of stairs as quickly as possible. Subjects were also evaluated for their joint pain while performing these activities, their leg strength, perceptions of joint pain, stiffness, functional ability, and other health status information. FINDINGS: This study indicates that knee extension strength (quadriceps), joint pain during the activity, perceptions of functional ability and body weight combined can predict between 39% and 56% of the variance in the time to perform four functional tasks in adults with OA of the knee. CONCLUSION: Interventions that improve quadriceps strength and reduce joint pain and body weight along with facilitating perceptions of functional ability may have a positive impact upon the ability to get down to and rise up off of the floor and ascend/descend stairs in adults with OA of the knee.

Coping methods of patients with inflammatory bowel disease and prediction of perceived health, functional status, and well-being.

Inflammatory bowel disease (IBD) is chronic, incurable, and requires that affected patients cope with their condition on a constant basis. The purpose of this descriptive study was to predict the perceived health, functioning, and well-being among patients with IBD through the use and effectiveness of various coping methods. Forty-six patients with IBD completed the Jalowiec Coping Scale, the Health Status Questionnaire, and a demographic questionnaire. Results indicate that use of evasive, fatalistic, and emotive coping methods along with optimistic coping effectiveness were significantly inversely correlated with health perception and well-being. No coping effectiveness variables and only the use of evasive, fatalistic, and supportive coping methods were significantly inversely correlated with perceived functioning. Regression analysis indicated that 20% of the variance in health perception could be predicted from the use of emotive coping method. Fatalistic coping method use explained 24% of the variance in perceived functioning. Finally, 51% of the variability in perceived well-being could be predicted from the use of fatalistic coping method and the effectiveness of optimistic method. These findings indicate that emotion-focused coping methods are important predictors of the health, functioning, and well-being perceptions of patients with IBD.

Effect of a clinical case manager/clinical nurse specialist on patients hospitalized with congestive heart failure.

The purpose of this study was to evaluate the effect of case management by a Clinical Case Manager/Clinical Nurse Specialist (CCM/CNS) on hospitalized length of stay and hospital charge throughout a 12-month period for patients with congestive heart failure. A total of 491 patients were discharged during 1997 with a diagnosis-related group code of 127. Of this number, 88 were case managed by a CCM/CNS. The remaining 403 received the usual management of their care. The group who were case managed by the CCM/CNS demonstrated significantly shorter length of stay (t = 5.40, P < 0.00) and lower hospital charges (t = 4.26, P < 0.00) than the patients with congestive heart failure who were not case managed. Secondary analysis indicated a significant interaction between case management and involvement of a cardiologist in the care of the patient. Patients whose care involved a cardiologist without case management by a CCM/CNS demonstrated significantly greater (alpha = 0.01) length of stay and hospital charges than patients who were case managed by a CCM/CNS or patients whose care did not involve a cardiologist.

Balance and muscle strength as predictors of frailty among older adults.

The term frailty is increasingly used in gerontological literature and in practice. However, indicators differentiating frail from nonfrail are not well delineated. Identifying factors discriminating between frail and nonfrail older community-residing adults may lead to more comprehensive clinical assessments and targeted interventions to minimize or prevent frailty. Eighty-four adults, ages 60 to 88 (mean = 74) living independently in the community completed a functional performance questionnaire and a perceived health questionnaire that were combined as measures of frailty. Predictor variables of frailty included four measures of balance and three measures of lower leg strength. Discriminant analysis revealed that one balance score and dorsiflexion correctly classified 65% of group membership, with better prediction of the nonfrail than frail group. This study clarifies that the predictors of frailty include the combination of dorsiflexion strength and balance, specifically the contribution of vision to balance when the support surface is compliant. Recommendations are proposed for conceptualizing and operationalizing frailty and adding variables to enhance discrimination between frailty and nonfrailty. Nursing implications include adding clinical assessments of specific components of balance and ankle strength to develop a more comprehensive evaluation of frailty.

Use of magnet therapy to heal an abdominal wound: a case study.

Complementary therapies, in particular magnet therapy, may have benefits to offer in healing chronic wounds. This case study involves a 51 year old paraplegic woman with an abdominal wound that had been present for one year. Traditional approaches to wound care had not achieved complete healing. Prior to surgical intervention, the patient consented to the application of magnet therapy over her usual wound dressing. In one month, the wound completely healed. On the basis of this case, further investigation of magnet therapy for wound healing appears to be warranted.

Can providing paging devices relieve waiting room anxiety?

The purpose of this study was to evaluate the effect of providing individuals who are waiting for surgical patients with digital pagers. Twenty-eight subjects received routine waiting room procedures, and 29 subjects were given digital pagers during surgical procedures. Subjects completed questionnaires concerning activity, state anxiety, and their perceived threat while patients were undergoing surgical procedures. The group that received the paging devices reported significantly greater state anxiety (i.e., P < .03) and a greater percentage of time spent outside surgical waiting rooms (i.e., P < .00) than the group that did not receive paging devices.

Determinants of four functional tasks among older adults: an exploratory regression analysis.

Functional ability declines in later life. The purpose of this project was to determine if strength, postural control, and joint pain predict performance of four functional tasks among older adults. A sample of 28 older adults completed assessments of strength, postural control, joint pain, and four functional tasks. The duration to complete the functional tasks of: 1) getting out of bed, going to a chair, and then returning to bed; 2) crossing a street and getting onto a bus; 3) exiting the passenger side of a car; and 4) climbing a flight of 27 stairs was recorded. Step-wise regression equations indicated that seated row strength and dynamic postural control were significant predictors of all of the tasks and accounted for the largest proportion of the variance in each equation. These results indicate that measures of physical fitness may be more important predictors of functional tasks among older adults than chronological age.

Postural control and strength and mood among older adults.

Falls are a significant problem among older adults. Reported correlates of older adult falls have included determinations in leg muscle strength and declines in postural control. However, some investigators have reported low correlations between measures of strength and postural control among older adults. Other investigators have reported that attention demands in this group are inversely related to their postural control. No study has attempted to predict postural control from mood precursors or from knee and ankle strength among older adults. The purpose of this study was to examine relationships between postural control and strength and mood precursors to attention among older adults. Twenty-seven older adults (m = 73.8 years) completed the 16-item Mood Response Scale, which measures total mood, and three subscales conceptualized to be precursors of the subject's ability to focus attention: alertness, contentedness, and calmness. Measures of each subject's isometric knee and ankle strength and postural control also were collected. Using stepwise regression analysis the investigators found that alertness accounted for the greatest amount of variance in all three measures of postural control (R2 = 20 to 27). Additionally, ankle strength, calmness, and age considerably increased the explained variance in postural sway with eyes closed (total R2 = 416). Age was not a significant predictor of the other two measures of postural control. The findings suggest that alertness, a precursor to attention among older adults, is a significant predictor of postural control when vision is intact but that other factors assume importance when vision is impaired. These findings indicate that the postural stability of older adults may be improved, and falls reduced, through interventions which enhance the alertness and attention among older adults.

Effect of resistance training on strength, postural control, and gait velocity among older adults.

The purpose of this study was to examine the effects of a 14-week resistance training program on the ankle strength, training intensity, postural control, and gait velocity of older adults. Forty-two older adults (mean age = 72), 21 in the resistance and control groups, completed the 14-week project. The resistance training group participated in 14 weeks of resistance training three times per week using elastic bands (Theraband) for resistance. Isokinetic ankle strength, training intensity, postural stability, and gait velocity were measured prior to and following the 14-week intervention. Following the training, the resistance group exhibited improved ankle dorsiflexion, training resistances, and gait velocity, but showed no change in plantar flexion or postural control. The control group also exhibited improvements in dorsiflexion, but these gains were approximately one-half of the gains observed in the resistance training group. Finally, when adjusted for baseline differences, subjects in the resistance training group demonstrated no changes in the dependent measures over the control group.

Developing a strength training program for older adults: planning, programming, and potential outcomes.

Muscle strength is important to older adults in maintaining an independent lifestyle and completing activities of daily living. In this article, the authors discuss changes in muscular functioning that commonly accompany the disuse associated with aging, as well as the impact that strength training can have on the older adult's muscle functioning. The article presents the essential components of developing a strength training program: pretesting, setting individualized goals, designing a strength training program, and establishing methods to evaluate the participants' progress. It also lists the benefits of strengthening particular muscle groups. Strength training programs for older adults should be developed on the basis of individualized expectations and goals, with the ultimate goal of facilitating the older individual's lifestyle and independence. Older adults who have participated in a strength training program have reported the following benefits of participation: improved body image, greater flexibility, increased strength, and increased self-confidence.

The effects of attendance and effort on outcomes among older adults in a long-term exercise program.

To determine if attendance and effort could differentiate changes in cognitive and physical functioning, 66 older adults received a prescription heart rate to be achieved during supervised regular exercise sessions over a 9-month period. These 30-min sessions of aerobic training on a cycle ergometer were conducted three times per week. Cognitive variables and physical functioning were measured at baseline and following 4.5 months and 9 months of training. Attendance and effort scores (ATTEFF) were used to divide subjects into low ATTEFF (N = 29) and high ATTEFF (N = 37) groups. Following 9 months of training these groups were significantly different on life satisfaction and selected measures of health perception, but not on measures of either mental status or submaximum or resting heart rate. Maximum physical functioning improved within both groups, although the high ATTEFF group had improved more than the low ATTEFF group at posttest. Attendance and effort appear to differentiate older adults on selected measures of health perception and maximum physical functioning following a 9-month exercise program.

Efficacy of a home-based training program for older adults using elastic tubing.

The purpose of this study was to investigate the efficacy of, and the adherence to, a 12-week home-based progressive resistance training program for older adults utilizing elastic tubing. Sixty-two adults (mean age, 71.2 years) qualified to participate in the study. Subjects were randomly assigned to either the exercise (E) (n = 31) or non-exercise (NE) group (n = 31). Pre- and post-testing included isokinetic (1.05 rad.s-1) concentric/eccentric knee extension/flexion strength testing and flexibility measures of the hip, knee, and ankle. The E group trained three times per week, performing one to three sets of 10-12 repetitions for each of 12 resistance exercises. The exercises involved muscles of both the lower and upper body. Within the E group, 25 of the 31 subjects (80.6%) completed the study. Of the E subjects completing the study adherence to the three training sessions per week was 90% (range 72%-100%). Training resistances used during workouts increased significantly with the average estimated increase being 82% (P < 0.001). The E group also demonstrated significant (P < 0.05) increases in isokinetic eccentric knee extension (12%) and flexion (10%) strength. No other significant changes were observed between E and NE groups. These results suggest that home-based resistance training programs utilizing elastic tubing can serve as a practical and effective means of eliciting strength gains in adults over the age of 65.

The effect of a 12-week dynamic resistance strength training program on gait velocity and balance of older adults.

This study tested whether a 12-week dynamic resistance strength training program can change gait velocity and improve measures of balance among adults age 65 and older. Fifty-five community-dwelling adults (mean age = 71.1) were randomized into an exercise (n = 25) or control (n = 30) group. The exercisers were requested to complete three bouts of strength training per week for 12 weeks using elastic tubing. At posttest the exercisers demonstrated slower gait velocity, enhanced balance, and an improved ability to walk backward, although none of these posttest measures was significantly different from the control group.

Developing a reciprocal program between student nurse organizations and hospitals.

Student nurse organizations can develop reciprocal programs with hospitals which can be mutually beneficial to both organizations. Hospitals need to recruit and retain qualified nurses through cost-effective methods. NSAs need to develop financial support for their group's activities. Both the hospital and the NSA need to expose students to various nursing roles in an effort to reduce reality shock. Developing a reciprocal relationship between an NSA and a hospital is one method of meeting the complementary objectives of both organizations.