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1.
J Obstet Gynecol Neonatal Nurs ; 49(1): 101-112, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31758912

RESUMO

OBJECTIVE: To develop and evaluate an instrument designed to measure the confidence of nurses in their ability to provide neutral, compassionate care to unique families in perinatal settings: the Nurses' Confidence Scale: Unique Families. DESIGN: Prospective instrument development and psychometric study. SETTING: Health system in the U.S. Mountain West region. PARTICIPANTS: Convenience sample of 62 perinatal/neonatal nurses. METHODS: We developed a two-part scale to measure the confidence of nurses in their ability to care for complex/nontraditional families, termed unique families. Part A was focused on nursing care behaviors for any unique family; Part B was focused on providing care to seven specific unique family populations. Five experts in perinatal nursing or adoption evaluated the scale's content validity. To test the psychometric properties of the scale, we used item analysis, reliability analysis, and exploratory factor analysis. RESULTS: The content validity index was 0.82. The Cronbach's alpha coefficient estimate of internal consistency for Part A was .92. Principal component analysis resulted in two factors that explained 64% of the total variance: skills and resources (Cronbach's alpha coefficient = .89) and awareness and sensitivity (Cronbach's alpha coefficient = .87). Part B had a Cronbach's alpha coefficient of .90. Parts A and B showed a strong positive relationship with one another (r = .77). The general self-efficacy measure was strongly and positively correlated with Part A (r = .81) and moderately and positively correlated with Part B (r = .48). CONCLUSION: The Nurses' Confidence Scale: Unique Families is a new tool with which to measure the confidence of perinatal/neonatal nurses in providing sensitive, specific care to complex/nontraditional families. Results of our psychometric evaluation supported initial acceptable reliability and validity of the scale.

2.
Glob Pediatr Health ; 6: 2333794X19847911, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31106248

RESUMO

This study uses a secondary analysis of the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) to describe care coordination (CC) for children with medical complexity (CMC). Chi-square test, t test, and multivariate logistic regression statistical tests are used to determine the relationships and differences between sources of CC and factors associated with receiving clinic-based CC for CMC and their family. Among CMC, 66.47% received no CC support and 25.73% received clinic-based CC. In multivariate models, families reporting dissatisfaction with communication between health care providers or reporting family-centered care were less likely to receive clinic-based CC. Families were more likely to receive clinic-based CC if they had younger children, lower household income, and greater school absenteeism. Clinic-based CC is associated with improved communication between health providers but must become more family-centered and minimize student absenteeism for the CMC population.

3.
Front Public Health ; 6: 348, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30534549

RESUMO

Advances in the care and treatment of cystic fibrosis (CF) have led to improved mortality rates; therefore, considerably more individuals with CF are living into adulthood. With an increased number of CF patients advancing into adulthood, there is the need for more research that surrounds the aging adult CF patient. It is important to conduct research and collect results on the aging CF population to help better prepare the CF patient, who is dealing with the heavy treatment and financial burden of their disease, build autonomy and increase their quality of life. Of note, research has found that social, behavioral, and physical factors influence the ability of those with CF to follow dietary recommendations. A primary treatment goal in CF is a high calorie, high protein, and high fat diet. A socio-economic factor that has not been adequately investigated with regards to dietary compliance of individuals with CF is food insecurity. The aim of this community case study was to document the experiences and estimate the prevalence of food insecurity among CF patients residing in Idaho. The correlation between food insecurity and health outcomes (lung function and body mass index) was also examined. Participants included adult patients and parents of pediatric patients with CF. Food insecurity rates among CF patients of all ages were found to be significantly higher than that seen in the overall community; however, no specific correlation between food insecurity and body mass index (BMI) or lung function emerged. This case study highlights the need for continued research around food access issues in this patient population. The data resulting from this study shows the value of CF advocacy organizations promoting efforts to build resources and provide education around food insecurity issues.

4.
Clin J Oncol Nurs ; 22(6): 666-668, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30452009

RESUMO

NO SToPS is an interprofessional supportive care program implemented in 2008 for patients with head and neck cancer undergoing chemoradiation. The goals of the program are to reduce radiation treatment breaks and hospitalizations related to toxicity from this difficult treatment. Breaks lead to lower locoregional control and survival rates in this population. This article describes the effect of the NO SToPS program.


Assuntos
Agendamento de Consultas , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Neoplasias de Cabeça e Pescoço/terapia , Equipe de Assistência ao Paciente/organização & administração , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Hospitalização/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Prognóstico , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Grupos de Autoajuda/organização & administração , Análise de Sobrevida
5.
PLoS One ; 13(9): e0199838, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30235221

RESUMO

Research utilizing repeated-measures such as daily assessments with self-report and/or objective measures [e.g., physical activity (PA) monitors] are important in understanding health behaviors and informing practice and policy. However, studies that utilize daily assessment often encounter issues with attrition and non-compliance. The current research yielded high levels of retention and adherence with both self-report and objective daily measures. The purpose of this paper is to highlight and discuss strategies utilized in maximizing retention, minimizing missing data, and some lessons learned from the research experience. Fifty community participants took part in a 4-week study utilizing both daily self-report questionnaires and daily use of PA monitors (Fitbit One™). This study focused on typical daily PA and was not an intervention study (e.g., participants were not randomized nor asked to change their PA behavior). Participants completed the study in two waves (wave 1 n = 10, wave 2 n = 40). The research team utilized several retention strategies including automating the data collection process, a prorated incentive structure, having a dedicated and responsive study staff, and utilizing the 2-wave process to optimize data collection during the 2nd wave. The study had 100% retention and generally positive anonymous feedback post-study. Overall, participants completed the vast majority of daily surveys (97%) and wore their Fitbits (for at least part of the day) on almost all days (99.57%) of the study, although there were individual differences. The strategies discussed and lessons learned may be useful to other researchers using daily measurements for whom adherence and retention are important issues. Future research employing these strategies in different populations, with different measurements, and for longer durations is warranted to determine generalizability.


Assuntos
Atividades Cotidianas , Exercício , Cooperação do Paciente , Autorrelato , Inquéritos e Questionários , Adulto , Feminino , Humanos , Masculino
6.
Nurs Womens Health ; 22(3): 219-227, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29885710

RESUMO

OBJECTIVE: The purpose of this quality improvement project was to plan and implement a daily family bonding time on our mother/baby care unit and evaluate its effect on interruptions, mothers' perceptions of interruptions, and exclusive breastfeeding rates. DESIGN: A separate sample pre-/postintervention design conducted in three phases. SETTING/LOCAL PROBLEM: Healthy breastfeeding newborns had double the odds of receiving supplementation before discharge if they stayed more than 1 night or were born at night. Night nurses suggested implementing a daily quiet time as a strategy for limiting interruptions. PARTICIPANTS: A convenience sample of 60 postpartum women. INTERVENTION/MEASURES: During Phases 1 and 3, data were collected on interruptions (number, duration, and by whom), women's perceptions of interruptions, and exclusive breastfeeding rates. Family bonding time was launched in Phase 2 during the hours of 2 p.m. to 4 p.m. Women were encouraged to rest with their newborns in their rooms; interruptions were limited to those that were urgent, medically necessary, or requested by the women. RESULTS: Outcome data were analyzed using descriptive statistics, a repeated-measures analysis of variance, t test, and chi-square test. Analysis of interruptions by the unit nursing staff indicated a decrease in interruptions between 2 p.m. and 4 p.m. that could be attributed to family bonding time (F(1, 58) = 7.50, p = .008). Analysis of interruptions by other hospital staff and visitors indicated a significant interaction of time with interruptions; interruptions decreased in both phases between 2 p.m. and 4 p.m. (F(3, 174) = 4.83, p = .0029; F(3, 174) = 2.95, p = .034). Exclusive breastfeeding rates increased significantly (χ2(4) = 21.27, p = .0003); there were no significant differences in women's perceptions of interruptions. CONCLUSION: New mothers experience many interruptions during their hospital stays, particularly when visitors arrive in large groups and stay more than 60 minutes. Documenting sources of interruptions before launching family bonding time helps identify hospital staff who need to be informed. Addressing their concerns before implementation can facilitate project sustainability.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Relações Mãe-Filho/psicologia , Mães/psicologia , Apego ao Objeto , Isolamento Social , Visitas a Pacientes/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital , Melhoria de Qualidade , Fatores de Tempo
7.
Transl Behav Med ; 8(3): 366-374, 2018 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-29800407

RESUMO

There is need for effective venues to allow teams to coordinate care for high-risk or high-need patients. In addition, health systems need to assess the impact of such approaches on outcomes related to chronic health conditions and patient utilization. We evaluate the clinical impact of a novel case conference involving colocated trainees and supervisors in an interprofessional academic primary care clinic. The study utilized a prospective cohort with control group. Intervention patients (N = 104) were matched with controls (N = 104) from the same provider's panel using propensity scores based on age, gender, risk predictors, and prior utilization patterns. Clinical outcomes and subsequent utilization patterns were compared prior to and up to 6 months following the conference. In terms of utilization, intervention patients demonstrated increased visits with primary care team members (p = .0002) compared with controls, without a corresponding increase in the number of primary care providers' visits. There was a trend towards decreased urgent care and emergency visits (p = .07) and a significant decrease in the rate of hospitalizations (p = .04). Patients with poorly-controlled hypertension saw significant decreases in mean systolic blood pressure from 167 to 146 mm Hg. However, there were no differences between the intervention and control groups. Intervention patients with diabetes demonstrated a nonsignificant trend towards decreased hemoglobin A1c from 9.8 to 9.4, when compared with controls. Interprofessional case conferences have potential to improve care coordination and may be associated with improved disease management, decreased unplanned care, and overall reduced hospitalizations.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Equipe de Assistência ao Paciente , Atenção Primária à Saúde , Idoso , Assistência Ambulatorial , Estudos de Casos e Controles , Feminino , Seguimentos , Hospitalização , Humanos , Masculino , Atenção Primária à Saúde/métodos , Pontuação de Propensão , Estudos Prospectivos , Qualidade da Assistência à Saúde
8.
Transl Behav Med ; 8(6): 927-931, 2018 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-29385577

RESUMO

Transition to interprofessional team-based care is a quickly progressing healthcare model and requires changes in medical training approaches. The Department of Veteran Affairs (VA) has taken a lead role in creating such training experiences, one of which is the establishment of multiple Centers of Excellence in Primary Care Education (CoEPCE). These sites are tasked with developing teaching innovations to better facilitate interprofessional team-based care. The patient-aligned care team interprofessional care update (PACT-ICU) is an interprofessional workplace learning activity with the goals of simultaneously addressing educational and patient care needs. Participants of the PACT-ICU included trainees and faculty of a variety of medical disciplines (e.g., internal medicine, psychology, and pharmacy) involved in a training primary care clinic. Two medically complex patients were presented at each PACT-ICU conference with the purpose of creating a plan of care that maintained an interprofessional team-based approach. Following implementation of the PACT-ICU conference intervention, two primary outcomes were assessed. First, self-assessment of PACT-ICU attendee learner outcomes was measured using a brief questionnaire surveying knowledge gain as it related to increase in knowledge of other professions' capabilities, roles, and responsibilities. Secondly, trainee provider behavior change was evaluated by measuring number of "within PACT" consults before and after participating in PACT-ICU. There was a significant positive change in self-assessed knowledge along with an indication of trainee behavioral change, as measured by electronic medical record consult patterns. This study demonstrates that interprofessional case conferences involving trainees and staff from multiple professions can increase awareness of other professions roles in patient care as well as facilitate interprofessional collaboration.


Assuntos
Competência Clínica , Educação Continuada/métodos , Pessoal de Saúde/educação , Capacitação em Serviço/métodos , Relações Interprofissionais , Equipe de Assistência ao Paciente , Atenção Primária à Saúde , Adulto , Humanos , Estados Unidos , United States Department of Veterans Affairs
9.
Acad Med ; 91(6): 798-802, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27008359

RESUMO

PROBLEM: As health care systems convert to team-based care, the need to improve interprofessional education is tremendous. In addition to formal instruction, trainees need authentic team-based workplace learning experiences. APPROACH: The authors designed the PACT-ICU (Patient-Aligned Care Team Interprofessional Care Update) conference to provide team-based care to high-risk patients while teaching trainees principles of interprofessionalism and modeling relevant behaviors. Trainees, supervisors, and affiliated support staff from the fields of internal medicine, nurse practitioner, pharmacy, psychology, and nursing all participate in this conference. During the conference, each participant focuses on the narrative of the patient's illness from his/her own professional perspective. A multifaceted care plan with specific action items is the product of the conference. To evaluate this workplace learning opportunity, the authors recorded patient characteristics, plus trainees' participation and satisfaction. OUTCOMES: Over the first 16 months (2013-2014) of the PACT-ICU, 33 trainees presented 79 patients. Each trainee presented two or three times each academic year. Patients were 90% male; their mean age was 64.5 years (SD 9.3, range 28-92), and their mean calculated 90-day risk of death or hospitalization was 22% (SD 14%, range 1%-45%).Overall, all surveyed trainees (n = 32; 97% response rate) expressed satisfaction, reporting that the conference was "helpful" or "very helpful" in developing treatment plans. NEXT STEPS: Further assessment of change in trainee behavior related to interprofessional team care, patient-level outcomes (e.g., quality of care and utilization), and factors facilitating dissemination of the model to other academic clinic settings is necessary.


Assuntos
Congressos como Assunto/organização & administração , Educação Continuada/métodos , Ocupações em Saúde/educação , Relações Interprofissionais , Equipe de Assistência ao Paciente , Atenção Primária à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Educação Continuada/organização & administração , Feminino , Humanos , Idaho , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Risco
11.
J Genet Couns ; 23(3): 323-9, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24155015

RESUMO

Advances in genetics are changing cancer care and requiring institutions to maximize the unique skills of genetics professionals. The identification of genetic syndromes is vital for prevention and management of families with high cancer risks. Despite this, high risk individuals who qualify are often not referred. Genetic counselors could review oncology charts to improve identification. A genetics assessment tool developed by NCI Community Cancer Centers Program was used to perform self-assessment of the genetics program. A weekly report of all new oncology patients was provided to a genetic counselor for chart review. In 2010, 58 % of all eligible patients (n = 152) were offered a genetics evaluation. In 2011 this improved to 70 % (n = 167), which was a statistically significant difference, X (2)(1) = 5.13, p = 0.02. By cancer site, ovarian cancer referrals also showed statistically significant improvement, X (2)(1) = 6.36, p = 0.01. Breast and colon referrals were improved but not significant. Over 10 months, 129 patients were identified through the chart review program. Three were confirmed to have a genetic mutation for a hereditary cancer syndrome. An average week included review of 73 charts for 10 medical oncologists, 4 radiation oncologists, and 4 pediatric oncologists which generated 60-80 min of work for the genetic counselor. This program improved patient identification and quality, and allowed physicians to become more aware of opportunities for genetic counseling and more patients to receive genetic counseling and testing.


Assuntos
Aconselhamento Genético , Auditoria Médica , Neoplasias/genética , Humanos , Neoplasias/diagnóstico , Recursos Humanos
12.
Acad Med ; 88(7): 997-1001, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23702529

RESUMO

PURPOSE: The Accreditation Council for Graduate Medical Education's (ACGME's) six-competency framework has not been validated across multiple stakeholders and sites. The objective of this study was to perform a multisite validation with five stakeholder groups. METHOD: This was a cross-sectional, observational study carried out from October to December, 2011, in the internal medicine residency continuity clinics of eight internal medicine residency programs in the Pacific Northwest, including a VA, two academic medical centers, a military medical center, and four private hospitals. The authors performed a cultural consensus analysis (CCA) and a convergent-discriminant analysis using previously developed statements based on internal medicine milestones related to the six competencies. Ten participants were included from each of five stakeholder groups: patients, nurses, residents, faculty members, and administrators from each training site (total: 400 participants). RESULTS: Moderate to high agreement and coherence for all groups were observed (CCA eigenvalue ratios ranging from 2.16 to 3.20); however, high differences in ranking order were seen between groups in four of the CCA statements, which may suggest between-group tension in these areas. Analyses revealed excellent construct validity (Zcontrast score of 5.323, P < .0001) for the six-competency framework. Average Spearman correlation between same-node statements was 0.012, and between different-node statements it was -0.096. CONCLUSIONS: The ACGME's six-competency framework has reasonable face and construct validity across multiple stakeholders and sites. Stakeholders appear to share a single mental model of competence in this learning environment. Data patterns suggest possible improvements to the competency-milestone framework.


Assuntos
Acreditação/normas , Competência Clínica/normas , Medicina Interna/educação , Internato e Residência/normas , Análise Discriminante , Humanos
13.
Health Phys ; 102(4): 443-52, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22378206

RESUMO

An exploratory epidemiological study was conducted for 319 deceased nuclear workers who had intakes of transuranic radionuclides and histories of employment during the time period from 1943 to 1995. The workers were employed at various facilities throughout the United States, including the Department of Energy defense facilities and uranium mining and milling sites. The majority of individuals were involved in documented radiological incidents during their careers. All had voluntarily agreed to donate their organs or whole body to the United States Transuranium and Uranium Registries. External and internal dose assessments were performed using occupational exposure histories and postmortem concentrations of transuranic radionuclides in critical organs. Statistical data analyses were performed to investigate the potential relationship between radiation exposure and causes of death within this population due to cancers of the lungs, liver, and all sites combined while controlling for the effects of other confounders. No association was found between radiation exposure and death due to cancer (α = 0.05). However, statistically significant associations were found between death due to any type of cancer and smoking (yes or no) (odds ratio = 5.41; 95% CI: 1.42 to 20.67) and rate of cigarette smoking (packs per day) (odds ratio = 2.70; 95% CI: 1.37 to 5.30).


Assuntos
Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/mortalidade , Exposição Ocupacional/efeitos adversos , Plutônio/efeitos adversos , Relação Dose-Resposta à Radiação , Humanos , Funções Verossimilhança , Masculino , Fatores de Tempo
14.
J Dent Educ ; 74(9): 970-9, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20837738

RESUMO

This study assessed perceptions of health professions student and faculty volunteers who participated with athletes at the 2009 Special Olympics World Winter Games in Healthy Athlete venues. The volunteers' perceptions and expectations of the abilities of intellectually disabled athletes were measured by administering pre-event and post-event questionnaires consisting of demographic questions and the Prognostic Belief Scale (PBS). Invitations to participate in the study were sent to 165 students and faculty members; of those, eighty (48.5 percent response rate) responded to the pre-event questionnaire, and sixty-seven (40.6 percent response rate) responded to the post-event questionnaire. Of the eighty respondents to the pre-event questionnaire, fifty-five (68.7 percent) also completed the post-event questionnaire. The ANOVA comparing pre- and post-event PBS scores between groups found a trend towards higher scores among the volunteers, but analysis did not demonstrate a significant effect in either group (p=.68) or the interaction of group by time (p=.46). Despite the findings from the PBS, participants' statements suggest the experience had an impact on their perceptions and expectations. Although not statistically significant, this study found a positive trend pre- to post-event in the volunteers' perceptions of the abilities of athletes with intellectual disabilities. In addition to didactic and clinical education, volunteer experiences may enhance care providers' knowledge, skill, and confidence levels for treating clients with intellectual disabilities.


Assuntos
Atitude do Pessoal de Saúde , Docentes , Pessoas com Deficiência Mental , Esportes , Estudantes de Ciências da Saúde/psicologia , Voluntários/psicologia , Adolescente , Adulto , Audiologia , Criança , Competência Clínica , Higienistas Dentários/psicologia , Dietética , Educação em Odontologia , Odontologia Geral , Humanos , Deficiência Intelectual , Internato e Residência , Relações Interpessoais , Pessoa de Meia-Idade , Relações Profissional-Paciente , Autoimagem , Patologia da Fala e Linguagem , Inquéritos e Questionários , Adulto Jovem
15.
J Med Pract Manage ; 25(2): 97-9, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19911544

RESUMO

Disasters have an enormous economic impact on the United States as well as short- and long-term healthcare implications. Federal and state governments are providing billions of dollars to communities across the nation for emergency preparedness activities. An online poll conducted in July 2008 indicated that most medical practices in the United States, even though they believe they will be impacted by a disaster within the next five years, re port themselves to be inadequately prepared. In light of increased funding since 9/11 and hurricane Katrina, the results of the poll show that the very practices that are the foundation of our healthcare system that see and treat patients on a daily basis are not being included in preparedness efforts.


Assuntos
Planejamento em Desastres/economia , Planejamento em Desastres/organização & administração , Emergências , Qualidade da Assistência à Saúde , Socorro em Desastres/organização & administração , Medidas de Segurança , Segurança Computacional , Custos de Cuidados de Saúde , Prioridades em Saúde , Humanos , Edifícios de Consultórios Médicos , Administração da Prática Médica/organização & administração , Socorro em Desastres/economia , Estados Unidos
16.
Neuropsychobiology ; 58(2): 104-10, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18843196

RESUMO

The literature remains contentious regarding the separate and combined effects of moderate drinking and estrogen replacement therapy (ERT) on cognition. In the current study, the authors sought to disentangle the predictive utility of alcohol use, ERT and their interaction on the episodic and semantic memory stores of postmenopausal women. It was predicted that relationships between moderate drinking, ERT and cognition would be attenuated by demographic and health-related factors. Postmenopausal women (n = 298) completed a battery of cognitive tests designed to assess speed and accuracy of episodic and knowledge-based cognitive processing. Potentially confounding variables were categorized and tested as mediators in hierarchical regression analyses. Moderate drinking was a weak predictor of episodic availability prior to removal of potential mediators. ERT use was a significant predictor of episodic and knowledge-based availability; no mediators were identified. Alcohol moderated ERT, as a combined alcohol/ERT variable was shown to be related to cognition. Neither moderate drinking nor ERT use was associated with cognitive speed. These findings suggest that positive relationships between alcohol and cognition are likely mediated by other variables, and should not be regarded as a benefit of drinking. Further, results support ERT as a predictor of knowledge-based and episodic availability, independent of mood stabilization or socioeconomic influences. Finally, alcohol and ERT appear to interact to impact both episodic and knowledge-based performance.


Assuntos
Consumo de Bebidas Alcoólicas/fisiopatologia , Álcoois/farmacologia , Cognição/efeitos dos fármacos , Estrogênios/uso terapêutico , Pós-Menopausa/efeitos dos fármacos , Feminino , Humanos , Memória/efeitos dos fármacos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Pós-Menopausa/fisiologia
17.
Alcohol Clin Exp Res ; 32(9): 1670-80, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18616686

RESUMO

BACKGROUND: While some reported benefits of moderate drinking are thought to be the direct results of physiological mechanisms associated with consumption, other effects may be attributable to mediating factors. Both explanations suggest that moderate drinkers may be healthier than nondrinking and heavier-drinking peers. The purpose of this study was to determine whether moderate-drinking postmenopausal women report healthier dietary and exercise patterns, and whether they demonstrate better physiological functioning compared with peers. This study also aimed to describe patterns of relationships between alcohol and measures of general health functioning in postmenopausal women. METHODS: One-hundred and fifteen women aged 50 to 65 participated. Participants completed alcohol interviews, diet and exercise questionnaires, and bone density examination. Blood pressure, height, and weight were assessed, and blood was collected to conduct basic chemistry and complete blood count tests. RESULTS: Postmenopausal moderate drinkers failed to demonstrate healthier dietary or exercise habits, and did not exhibit significantly better health-functioning compared with peers. They did evidence positive associations between drinking and healthy behavior, and between drinking and cardiovascular health. Relationships between alcohol and blood analytes differed between drinking groups, some of which suggested possible negative health consequences for higher-end drinkers in both drinking groups. CONCLUSIONS: These data suggested that moderate-drinking postmenopausal women are not significantly healthier than their non- or heavier-drinking peers, but may drink as part of a larger effort to take care of their health. Despite this, even 1-drink-per-drinking-day moderate drinkers may have tendencies toward unhealthy conditions. Limitations include small sample size, inability to assess specific cardiac risk and socioeconomic status, small number of correlations, and clinical relevance of analyte values.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Nível de Saúde , Pós-Menopausa/fisiologia , Idoso , Pressão Sanguínea/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Densidade Óssea/efeitos dos fármacos , Depressores do Sistema Nervoso Central/farmacologia , Dieta , Relação Dose-Resposta a Droga , Etanol/farmacologia , Exercício/fisiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Entrevistas como Assunto , Lipídeos/sangue , Pessoa de Meia-Idade
18.
J Addict Med ; 2(4): 202-14, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19347067

RESUMO

OBJECTIVES: It is widely recognized that individuals with alcohol or illicit substance abuse disorders often smoke cigarettes. However, few studies have examined the direct effects of nicotine among substance abuse subgroups. The current study examined patterns of electroencephalographic (EEG) activity in alcohol-dependent (AD), stimulant-dependent (StimD), alcohol- and stimulant-dependent (ASD) participants, as well as community controls (CC). All participants were regular smokers. METHODS: After overnight nicotine abstinence, subjects were administered either a high (14 or 21 mg) or low (7mg) dose transdermal nicotine patch. EEG data were collected during a 2 minute eyes open and 5 minute eyes closed baseline recording session, which occurred as part of a larger study of brain electrophysiology. RESULTS: The most interesting finding was a differential pattern of nicotine dose effects by group. EEGs of Controls and ASD participants did not distinguish between high and low nicotine doses; whereas, nicotine administration in the AD and StimD groups resulted in opposite findings across a range of spectral bands. CONCLUSIONS: Although further research is warranted, these results may have implications for the study of smoking cessation and attentional functioning among substance abusers in treatment. These data suggest that nicotine-related changes in neurophysiology may be associated with specific brain areas and/or specific drug histories and reinforce the need for caution in generalizing among such groups.

19.
Alcohol Clin Exp Res ; 31(12): 2083-91, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17949466

RESUMO

BACKGROUND: Historically, the concomitant use of nicotine among alcoholics has not been methodologically accounted for. Given the observed cognitive enhancing effects of acute nicotine on attentional processes, it is important that the potentially positive effects of nicotine be disentangled from the negative effects of chronic alcohol dependence. The current study was conducted to address this question and to test the hypothesis that alcoholics who are regular smokers are more sensitive to the effects of nicotine on cognition as compared to regular smoking community controls. METHODS: A 2 [drug group; alcoholics (n = 28), community controls (n = 27)] X 2 nicotine dose level [low (7 mg dose) vs. high (14 or 21 mg dose)] double-blind design was used to assess the differential effects of nicotine dose on a battery of neurocognitive tests focusing on attentional efficiency. RESULTS: As expected, the alcoholic group performed more poorly than did the control group. However, of greater interest to the current study was the finding that alcoholic participants differentially benefited from nicotine administration, as demonstrated in the differential dose effect. CONCLUSION: The concomitant use of nicotine may serve to "mask" or "overcome" some of the negative effects of chronic alcohol dependence in newly recovering alcoholics. This potential effect has significant implications for treatment development and further understanding of the process of recovery of function in chronic alcoholics.


Assuntos
Alcoolismo/psicologia , Atenção/efeitos dos fármacos , Estimulantes Ganglionares/farmacologia , Nicotina/farmacologia , Fumar/psicologia , Administração Cutânea , Adulto , Alcoolismo/reabilitação , Comorbidade , Relação Dose-Resposta a Droga , Etanol/toxicidade , Feminino , Humanos , Masculino , Memória de Curto Prazo/efeitos dos fármacos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Síndrome de Abstinência a Substâncias/psicologia
20.
Subst Use Misuse ; 42(4): 693-704, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17558958

RESUMO

Essential to clarifying the nature of health disparities and ultimately to developing appropriate responses is the access and availability of accurate, relevant data. This need is particularly obvious at the level of public health policy and practice. Unfortunately, current data sources are frequently restricted by a variety of factors, including jurisdictory limitations that restrict exchange of information between health delivery systems. This study was conducted to review conclusions drawn from disparate, yet functionally interdependent, data sources regarding alcohol-related medical outcomes among American Indians; specifically, non-reservation-residing Indian people. Data were collected from 1998 to 1999. The comparison revealed critical inconsistencies between data sources, reinforcing the call for enhanced data exchange and caution in interpreting data from singular sources.


Assuntos
Bases de Dados Factuais , Necessidades e Demandas de Serviços de Saúde , Índios Norte-Americanos , Transtornos Relacionados ao Uso de Substâncias , Alcoolismo , Humanos , Estados Unidos
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