Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa.

HIV/AIDS is taking a heavy toll on South African youth. Reducing their risk for HIV requires an understanding of the determinants of their HIV risk behaviours that are amendable to intervention-induced change. This study draws upon the theory of planned behaviour to identify the modifiable determinants of the intention to use condoms among Xhosa-speaking South African adolescents. The participants were 390 Xhosa-speaking 6th grade students (mean age = 12.1 years) in public schools in the township of Mdantsane, South Africa who completed an anonymous questionnaire. Multiple regression revealed that attitude and perceived behavioural control were significantly related to the intention to use condoms, whereas subjective norm was not, controlling for sexual experience, gender, and language preference. Consistent with this were additional analyses using beliefs as predictors: Hedonistic behavioural beliefs and control beliefs about condom-use negotiation and technical skills predicted intention, whereas normative beliefs did not. The theory of planned behaviour may be a useful model of condom use among Xhosa-speaking South African adolescents. An emphasis on beliefs about the adverse effects of condom use on sexual enjoyment, the ability to negotiate condom use, and the ability to use condoms correctly might improve the efficacy of HIV/STD interventions for such adolescents.

Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants.

OBJECTIVE: To describe 13 neurologically normal infants with chronic respiratory symptoms who had swallowing dysfunction with silent chronic aspiration without gastroesophageal reflux (GER) as the cause of their respiratory symptoms. BACKGROUND: Infants with neurologic disorders and infants with GER are known to have chronic respiratory symptoms. Isolated swallowing dysfunction and aspiration without GER in neurologically normal infants have not been widely reported. DESIGN: Retrospective chart review. SETTING: A tertiary pulmonary-care center at a children's hospital. PATIENTS: One hundred twelve otherwise healthy infants referred for respiratory symptoms who underwent esophageal pH studies and videofluoroscopic swallow studies (VSSs). METHODS: The records of infants referred between January 1997 and December 1999 to the Department of Pediatric Pulmonology who underwent 24-h esophageal pH monitoring and VSS as part of an evaluation for recurrent stridor and/or wheezing were reviewed. Significant GER was diagnosed if the percentage of time with esophageal pH < 4 was > 6%. Infants included in the study presented with recurrent respiratory symptoms, were born at term, were neurologically normal, had normal results of esophageal pH studies, but had abnormal results of VSSs (n = 13). RESULTS: All 13 infants presented with a variety of recurrent respiratory symptoms including wheezing and intermittent stridor. Ten of 13 infants had spitting and/or choking episodes with feeding. The mean (+/- SD) age at the onset of symptoms was 2.0 +/- 1.6 months, and the mean age at VSS was 5.9 +/- 3.4 months. All 13 infants had normal results of 24-h esophageal pH studies but had abnormal results for VSSs. All infants had evidence of swallowing dysfunction and direct silent aspiration of liquids with thin consistency. Six infants also were aspirating liquids with thick and/or semi-thick consistencies. None of the infants had evidence of structural anomalies on esophagograms. Nine infants were treated with thickened food, and in four infants oral feedings were stopped. Three of these infants required nasojejunal feeding, and one infant required gastrostomy tube feeding. VSSs were repeated every 3 months. In all infants, swallowing dysfunction resolved within 3 to 9 months. All infants tolerated the resumption of oral feeding. Videofluoroscopic documentation of the resolution of aspiration was followed by the resolution of respiratory symptoms in all infants. CONCLUSION: There is a subgroup of otherwise healthy infants, presenting with wheeze and/or stridor, who have isolated swallowing dysfunction and silent aspiration as the cause of their respiratory symptoms.

Serum and lower respiratory tract drug concentrations after tobramycin inhalation in young children with cystic fibrosis.

OBJECTIVES: To assess the serum and lower respiratory tract tobramycin concentrations (C(T)) produced by a single dose of tobramycin for inhalation delivered by a nebulizer and a compressor in patients with cystic fibrosis (CF) 6 months to 6 years of age. STUDY DESIGN: We performed a dose escalation study of serum C(T) measured before and 0.5, 1, 2, and 4 hours after a single dose of inhaled tobramycin, either 180 mg (10 patients) or 300 mg (19 patients). In a separate group of 12 patients, epithelial lining fluid (ELF) C(T) was measured by bronchoalveolar lavage 30 to 45 minutes after a 300-mg dose. RESULTS: A 180-mg dose of inhaled tobramycin produced a mean peak serum C(T) of 0.5 microg/mL (SD 0.4; range, <0.2 to 1.4 microg/mL). A 300-mg dose produced a mean peak serum C(T) of 0.6 microg/mL (SD 0.5; range, <0.2 to 1.2 microg/mL). These peak values are well below the accepted maximum trough concentration with parenteral dosing (2 microg/mL). The target ELF C(T) was 20 microg/mL, 10-fold greater than the minimal inhibitory concentration for most Pseudomonas aeruginosa isolates from very young patients with CF (2 microg/mL). Mean ELF C(T) was 90 microg/mL (SD 54; range, 16 to 204 microg/mL) and exceeded the target concentration in 11 patients. CONCLUSION: In patients with CF ages 6 months to 6 years, a single 300-mg dose of inhaled tobramycin appears to produce safe peak serum concentrations and drug concentrations in the bactericidal range in the lower respiratory tract.

Antidepressant prescribing practices of nurse practitioners.

Depression continues to be seriously underdiagnosed and undertreated in primary care settings. Many studies have observed antidepressant prescribing practices of nonpsychiatric physicians to discover why inadequate depression detection and treatment is pervasive. This article describes the first large, randomized study to investigate the antidepressant prescribing practices of NPs. This quantitative, descriptive study sought to determine the factors NPs consider when choosing an antidepressant, antidepressant prescribing frequency by NPs, types of antidepressants prescribed by NPs, and health problems that NPs are treating with antidepressants. The study's findings indicate that NPs should adhere more closely to established practice guidelines.

Impact of added rest breaks on the productivity and well being of workers.

The impact of frequent short rest breaks on the productivity and well being of a group of 30 workers in a meat-processing plant was studied. Two rest break schedules were tested, both of which provided 36 min of extra break time over the regular break schedule (30-min lunch and two 15-min breaks). In the first experimental rest break schedule, workers were given 12 3-min breaks evenly distributed over the workday (3-min break for every 27 min of work). In the second schedule, workers were given four 9-min breaks evenly distributed over the workday (9-min break every 51 min of work). Outcome measures included production rate and discomfort and stress ratings. Results showed that neither of the two experimental rest break schedules had a negative effect on production, and the 9-min break schedule improved discomfort ratings for the lower extremities. The workers in the study mostly preferred the 9-min rest break schedule, indicating that workers in general might not as readily accept fragmentation of break time into short, frequent breaks.

Compression of the trachea by the innominate artery in a 2-month-old child.

SUMMARY. We utilized improved methods for assessing airway structure and function to define the clinical significance of the innominate artery syndrome. Both infant pulmonary function tests (IPFT) and noninvasive controlled ventilation computed tomography (CVCT) were used, along with traditional diagnostic techniques in a 2-month-old child with compression of the trachea by the innominate artery. These tests provided objective documentation of functional impairment before surgery and improvement postoperatively. These tests should aid in the understanding of this controversial syndrome and help to further define treatment options.

Perceived barriers to teaching for critical thinking by BSN nursing faculty.

The ability to think critically is considered an essential skill of nursing graduates and competent nursing practice. Yet, the literature reports that teachers are having difficulty teaching for critical thinking and that critical thinking is lacking in new nursing graduates. This research study sought to identify barriers to the implementation of critical thinking teaching strategies by nursing faculty currently teaching in generic baccalaureate programs in Tennessee. Surveys were mailed to 262 nursing faculty; 194 were returned, and 175 were usable. Students' attitudes and expectations represented the single greatest barrier to the implementation of critical thinking teaching strategies, followed by time constraints and the perceived need to teach for content coverage. Recommendations to support and encourage faculty to teach for critical thinking are outlined.

A phase I study of adenovirus-mediated transfer of the human cystic fibrosis transmembrane conductance regulator gene to a lung segment of individuals with cystic fibrosis.

A third-generation adenoviral vector containing recombinant human cystic fibrosis transmembrane conductance regulator (CFTR) gene was delivered by bronchoscope in escalating doses to the conducting airway of 11 volunteers with cystic fibrosis. Assessments of dose-limiting toxicity (DLT), efficiency of gene transfer, and cell-mediated and humoral immune responses to vector administration were performed. DLT, manifest by flulike symptoms and transient radiographic infiltrates, was seen at 2.1 x 10(11) total viral particles. A highly specific assay for gene transfer was developed using in situ hybridization with an oligoprobe against unique vector sequence. Detectable gene transfer was observed in harvested bronchial epithelial cells (<1%) 4 days after vector instillation, which diminished to undetectable levels by day 43. Adenovirus-specific cell-mediated T cells were induced in most subjects, although only mild increases in systemic humoral immune response were observed. These results demonstrate that gene transfer to epithelium of the lower respiratory tract can be achieved in humans with adenoviral vectors but that efficiency is low and of short duration in the native CF airway.

Antidepressant prescribing practices of nurse practitioners.

Depression is considered a highly treatable illness, yet often it is inadequately treated by physicians in primary care settings. The economic and human cost of inadequate treatment is well documented. The purpose of this pilot study was to explore the antidepressant prescribing practices among a convenience sample of nurse practitioners (NPs) and to use the findings to refine the antidepressant therapy questionnaire for further use. A self-administered questionnaire was completed by 26 NPs. Results of the survey revealed that NPs in primary care settings frequently treat a wide variety of common mental health problems and prescribe antidepressant medications for a number of these disorders as well as for nonpsychiatric problems. Factors that influence the NPs' decision-making process in the selection of a particular antidepressant were found to vary among the NPs surveyed. Although 65% of the NPs felt that they were sufficiently informed about the available antidepressants to select the most appropriate drug for their clients, 77% believed they needed additional education on antidepressant medications, and all but one respondent reported willingness to attend continuing educational offerings on antidepressant medications.

Children's reactions to the receipt of direct and indirect help.

First, third, and fifth graders' (N = 201) reactions to 2 types of aid (direct help [answers] and indirect help [hints]) commonly used by helpers to assist children were examined. The children were randomly assigned to receive either direct or indirect help on a task, and then were asked to try a similar task immediately and again a few days later. Direct help was expected to elicit dependency, whereas indirect help was expected to elicit independent reactions. Age and/or sociocognitive level were predicted to moderate the effects of help. Direct help resulted in feelings of threat, low perceived control, and high dependency help-seeking for girls, but not for boys. Boys who received indirect help and understood the notion of consistency of personality requested less dependent help than did boys with less of this sociocognitive skill. Moreover, children high in the understanding of consistency of personality were more autonomous (i.e., helped themselves more) in the indirect than in the direct help condition.

Use of visual perception in estimating static postural stresses: magnitudes and sources of errors.

Very little is known about the magnitudes and sources of errors associated with the visual estimation of postural classification displayed on TV screens. This study was conducted to address this issue. Sixty-three subjects participated in the experiments. The findings indicate that: (1) subjects found it difficult to evaluate upper extremity postures (particularly the elbow and the wrist), while the postures around the lower back were the easiest to evaluate; (2) the lower extremity positions affected the ability of the subjects to accurately classify postures around the wrist, elbow, shoulder, neck, and lower back, with the estimates being > 70% for sitting and > 60% for standing (except for the elbow); and (3) in general, flexion and extension are easier to evaluate than neutral and non-neutral postures.

On the investigation of the neurophysiological correlates of knowledge worker mental fatigue using the EEG signal.

Technological trends and advances in automation have underscored the importance of task performance of certain jobs requiring mental functions such as information processing and decision analyses. Most experts agree that such work environments produce increased mental activities, with profound implications for mental fatigue and stress. Consequently, productivity measurement and improvement for white collar or 'knowledge worker' occupations remains a major challenge and concern. This investigation defines an experimental approach that examines the neurophysiological correlates of white collar worker mental fatigue using the EEG signal. A 6 h laboratory experiment was conducted to simulate work output. The methods of assessing fatigue employed were mental tests and physiological measurements. The experiment involved reading of standardized texts, finding solutions to arithmetic-logical problems and a combination of both task types. Two primary performance measures were obtained, work output and brain waves. Fast Fourier transform and correlation analyses are used to quantify the relationship between certain brain waves and mental fatigue. This research is a major step towards the development of a model that explores the relationship between mental fatigue and factors associated with output performance, optimal recuperation periods and related variables. Such a model would be useful in human reliability prediction based on task parameters and worker profiles.

Ergonomic risk assessment: preliminary guidelines for analysis of repetition, force and posture.

High repetition, excessive forces and awkward postures are a major cause of musculoskeletal disorders in industry. Thus, the main objective of this paper is to develop, based on the published literature, preliminary ergonomic guidelines for repetition, force, and posture task analysis. A method is also proposed which can be used to compute the interactive effects of repetition, force and posture.

The cross-ethnic equivalence of parenting and family interaction measures among Hispanic and Anglo-American families.

Recently there has been concern over the need for developmental research within ethnic minority populations and interest in family processes within, and variability across, ethnic groups. Unfortunately, most of the research using standard scales of family processes has sampled middle-class Anglo-Americans, and the potential absence of cross-ethnic measurement equivalence threatens the validity of the research using these scales with ethnic minority populations. This study reports confirmatory factor analyses and construct validity coefficients for several parenting and family interaction scales among Anglo-American and Hispanic 8-14-year-old children and mothers. The findings indicate that the Children's Report of Parental Behavior Inventory (except the hostile control subscale), the Parent-Adolescent Communication Scale (open communication subscale only), and the Family Adaptability and Cohesion Evaluation Scales II appear to have sufficient cross-ethnic equivalence for English-speaking Hispanic samples. Further, the Family Routines Inventory and the problem communication subscale could benefit from additional scale development.

Interpreting children's reports of concern about parental drinking: indicators of risk status?

Examined several self-report items traditionally used to identify children of alcoholics for their utility in identifying mental health risk status. The meaning of children's responses to these items was also examined. Collectively, these items reflected children's concern about their parents' drinking. Across multiple studies, children who reported concern about parental drinking reported higher levels of psychological and behavioral problems. This pattern existed whether or not children had a problem-drinking parent. Discriminant analyses with data from child and mother reports showed that children who reported concern were from homes with greater stress, lower income, and less supportive mother-child relationships.

A developmental model of recipients' reactions to aid.

A developmental model of recipients' reactions to aid, which is based on the threat-to-self-esteem model (the dominant theoretical framework in the field), is presented. Various refinements of the threat-to-self-esteem model are proposed to extend its range of applicability and heuristic value to encompass the study of children's reactions to aid. The moderating influences of developmental changes in cognitions regarding self and others, as well as in children's social environment, are examined. Literature from a variety of sources that is relevant to children's reactions to aid, or to processes that may be involved, is reviewed and discussed in light of our model.

A multi-level incentive model for service organizations.

Incentive programmes for production employees have been used for many years. However, more recently, there has been an increasing desire to use incentive programmes in service applications, particularly with the advent of electronic performance monitoring. This paper summarizes the methodology for developing a model that incorporates the parameters of quality (customer and supervisor evaluations), quantity of production, sales and individual goals. The model was used to compute incentive bonus payments for customer service employees who performed above standard. Employees were motivated by the incentive bonus, and thus productivity was increased. The model could be applied to any service organization. The model was developed to assist a customer service department where performance standards, quality measures or customer feedback were not firmly established. It measured objectively employee performance and rewarded the employee with individually calculated incentive bonuses through an electronically monitored system. The internal working of the model is a combination of the above parameters. Customized software was used to collect and tabulate customer feedback regarding a recent inquiry to the customer service department. This made up the first part of the quality measure for the department. The second part of the quality parameter was a regular evaluation by the supervisor. The quantity of production was measured by the number of inquiries handled per unit time. Sales were also calculated on a per-unit-time basis. The individual goals were the result of regular employee-supervisor meetings where past and future employee performance was discussed and mutually agreed upon. The five model parameters of quality (customer and supervisor), quantity, sales and individual goals are combined through the use of a linear equation. It was found that this form of employee evaluation worked very well in an electronic monitoring environment and was accepted by the participating work group. Overall, monthly productivity gains exceeded 15%.

A review and reappraisal of electronic performance monitoring, performance standards and stress allowances.

There is a growing trend toward electronic performance monitoring (EPM) to track the performance of workers engaged in computer-based tasks. Despite the possible productivity advantages of this approach to work management, the use of EPM may produce stress through work overload, negative computer feedback, loss of incentive pay and threat of job loss. These stress effects are most likely to occur among workers who have difficulty meeting work standards (eg, forms processed per hour) enforced through EPM. A stress allowance is proposed as a new category of work allowance for adjusting EPM work standards so as to minimize imbalances between task demands and the worker's resources to adapt.