Health Effects Reported by Adolescent Water Pipe and/or Cigarette Smokers Compared to Nonsmokers.

PURPOSE: The purpose of this study was to determine the prevalence of respiratory and/or physical fitness health problems in adolescent (ages 18-21) water pipe (WP) smokers (with or without cigarette smoking), cigarette-only smokers, and nonsmokers. METHODS: A comparative four-group study design was used to recruit a non-probability sample of 153 WP smokers only, 103 cigarette smokers only, and 102 cigarette+WP smokers along with 296 nonsmokers. Our hypothesis was that youth who smoked WPs and/or cigarettes would report more respiratory problems and/or poorer physical fitness than those who did not smoke. RESULTS: The results showed that coughs were significantly associated with smoking in all three of the smoking groups (p < .05). Cigarette-only smokers reported the most adverse outcomes with more wheezing, difficulty breathing, and less ability to exercise without shortness of breath. A dose-response analysis showed similar patterns of adverse health effects for both WP and cigarette smokers. The combined use of both products was not appreciably worse than smoking one product alone. This could be due to cigarette+WP smokers' reporting using less of the respective products when only one product was smoked. CONCLUSIONS: Even during the adolescent years, WP and/or cigarette smoking youth experienced reportable negative health effects.

Getting to Normal: Women's Experiences Self-Managing Their Perceived Blood Pressure Changes.

BACKGROUND: In the United States, nearly 25% of all women older than 20 years have hypertension (HTN). Nearly 30% to 50% of persons with HTN experience symptoms attributed to high blood pressure (BP). Women with hypertensive symptoms may connect their symptoms to perceived BP changes and may be using their perceptions about BP changes to guide their HTN self-management. There is limited research about perceived BP changes or their use in self-management. OBJECTIVE: The purpose of this qualitative study is to describe the experiences of women with HTN self-managing their perceived BP changes. METHODS: van Manen's phenomenology methodology and method guided the inquiry. Women with HTN who believed they could tell when their BP changed based on their symptoms were recruited from community settings and were interviewed once with a semistructured guide. Interviews were digitally recorded and professionally transcribed. Textual data were analyzed using thematic analysis to identify major themes. RESULTS: Seven black and 6 white women comprised the study sample. Participants were middle aged (mean [SD], 50.5 [9.62] years), were experienced in living with HTN (mean [SD],10.76 [9.50] years), had at least a high school education, and had a limited annual income (93% <$24 000). One central theme ("getting to normal") and 4 subthemes (i.e., "I can tell," "tending to it," "the wake-up call," and "doing it right") were discovered in the data. The themes depict a process of episodic symptom-driven and day-to-day actions that the participants used to get their BP to normal. CONCLUSIONS: The study is significant as new knowledge was discovered about how women perceive their BP changes and use them to guide self-management. This study contributes to clinical practice through suggestions for improving patient assessments. Results serve as a foundation for further research of the self-management of BP changes and developing belief-based interventions with the potential to improve BP control.

Symptom burden and quality of life in survivorship: a review of the literature.

BACKGROUND: Cancer has a great impact on the well-being of affected persons and their caregivers long into survivorship. OBJECTIVE: This article reviews the state of science on the survivorship experience of cancer survivors and caregivers, with a focus on symptom burden and quality of life (QOL) after treatment termination. METHODS: The primary databases utilized included PubMed and CINAHL. Search results were limited to human participants, English language, and publications from 2008 to 2013. The articles retrieved included studies of prostate, breast, colorectal, and gynecologic cancers during adulthood. RESULTS: As many as a third of cancer survivors experienced symptoms after treatment cessation equivalent to those experienced during treatment. Fatigue, depression or mood disturbance, sleep disruption, pain, and cognitive limitation were commonly reported by survivors across various malignancies; depression, anxiety, and sleep disturbance affected some caregivers. The studies indicated residual symptoms that extend into survivorship have a great impact on QOL and are associated with disability and healthcare utilization. Younger age, lower socioeconomic status, and increased comorbidities are associated with poorer QOL and higher symptom distress in cancer survivors. Younger age and lower income are associated with greater distress and poorer QOL in caregivers. CONCLUSIONS: Survivors and caregivers struggle with symptom burden and diminished QOL long into survivorship. Longitudinal studies are needed to investigate the persistence and severity of symptom burden over time as well as long-term and late effects of these symptoms. IMPLICATIONS FOR PRACTICE: Interventions designed to help alleviate symptom burden in those most affected are needed.

Partners' long-term appraisal of their caregiving experience, marital satisfaction, sexual satisfaction, and quality of life 2 years after prostate cancer treatment.

BACKGROUND: Partners of men treated for prostate cancer report more emotional distress associated with a diagnosis of prostate cancer than the men report; the duration of distress for partners is seldom examined. OBJECTIVES: The purpose of this study was to determine the long-term effects of prostate cancer treatment on partners' appraisal of their caregiving experience, marital satisfaction, sexual satisfaction, and quality of life (QOL) and factors related to these variables. METHODS: This exploratory study evaluated QOL among spouses of prostate cancer survivors at 24 months after treatment. Partners completed a battery of self-report questionnaires in a computer-assisted telephone interview. RESULTS: The sample consisted of 121 partners with average age of 60 years. There was a significant relationship between partners' perceptions of bother about the man's treatment outcomes and negative appraisal of their caregiving experience and poorer QOL. Younger partners who had a more negative appraisal of caregiving also had significantly worse QOL. CONCLUSIONS: Men's treatment outcomes continued to bother the partner and resulted in more negative appraisal and lower QOL 2 years after initial prostate cancer treatment. Younger partners may be at greater risk of poorer QOL outcomes especially if they have a more negative view of their caregiving experience. IMPLICATIONS FOR PRACTICE: Findings support prior research indicating that prostate cancer affects not only the person diagnosed with the disease but also his partner. Partners may benefit from tailored interventions designed to decrease negative appraisal and improve symptom management and QOL during the survivorship period.

Qualitative analysis of couples' experience with prostate cancer by age cohort.

Prostate cancer is a significant cause of morbidity and mortality in men in all adult life stages. Normative developmental tasks of aging combined with disease-related stressors may negatively affect adjustment to prostate cancer and, consequently, affect the quality of life of both the man and his spouse. The purpose of this study was to examine the experiences of men with prostate cancer and their partners according to their life cycle cohort: 50-64 (late middle age), 65-74 (young-old), and 75-84 (old-old). Qualitative interviews with 15 couples were used to provide information about the dyad's experiences with prostate cancer. Interview data were analyzed to identify preliminary coding schemas, which were subsequently refined and modified into themes. Three major themes were identified from the data. Across all age groups, prostate cancer had a significant effect on: (1) couples' daily lives, (2) their dyadic and family relationships, and (3) their developmental stage. There were also differences in age groups. Couples in the late middle age group reported greater disappointment and anger at their inability to reach life goals and establish financial security. Couples in the young-old group made more spontaneous comments about being satisfied with their life than the couples in the other 2 groups. Couples in the old-old group reported slower recovery from the illness than the younger couples. Results indicate that although prostate cancer may have some universal effects on couples, it also may have differential effects by age cohort. Hence, targeted interventions by age cohort may be warranted.

Pilot study of a Web-based compliance monitoring device for patients with congestive heart failure.

BACKGROUND: Web-based home care monitoring systems can assess medication compliance, health status, quality of life, and physiologic parameters. They may help overcome some of the limitations associated with current congestive heart failure management models. OBJECTIVES: This pilot study compared the effects of a self-care and medication compliance device, linked to a Web-based monitoring system, to the effects of usual care alone on compliance with recommended self-care behaviors; medication taking; quality of life; distance walked during a 6-minute walk test; and New York Heart Association Functional Class. We also assessed patient experiences living with the compliance device. METHODS: We enrolled 18 patients with Functional Class II-III congestive heart failure in an urban VA Medical Center. The patients were randomized into 2 groups. Group A received usual care plus the compliance device. Group B (controls) received usual care only. Data were collected using the compliance device, the Heart Failure Self-Care Behavior Scale, pill counts, 6-minute walk test, and the Minnesota Living with Heart Failure Questionnaire at baseline and at 3 months follow-up. RESULTS: At baseline and at 3 months, there were no differences between the compliance device group and the usual care group in self-care behaviors, pill counts, 6-minute walk-test distance, or Functional Class. However, quality of life improved significantly from baseline to 3-month follow-up (ANOVA, P =.006). This difference was due to an improvement in quality of life for the monitor group (P =.002) but not the usual care only group (P =.113). Patients in the compliance device group had a 94% medication compliance rate, 81% compliance with daily blood pressure monitoring, and 85% compliance with daily weight monitoring as compared to 51% for blood pressure monitoring and 79% for weight monitoring in the usual care group (P = NS). CONCLUSION: These are promising pilot results that, if replicated in a larger sample, may significantly improve care and outcomes for patients with heart failure.