Mothers' and fathers' views of family management and health-related quality of life for young adult survivors of childhood brain tumors.

PURPOSE: To examine associations between fathers' and mothers' appraisals of family management and physical and emotional health-related quality of life (QOL) for young adult survivors of childhood brain tumors. DESIGN: Cross-sectional. SAMPLE: 47 mothers and 39 fathers (39-67 years old); 47 survivors (18-33 years old). METHODS: Analyses evaluated relationships among family management (Survivor's Daily Life, Condition Management Ability, Condition Management Effort, Family Life Difficulty, View of Condition Impact, Parental Mutuality), quality of life, and parental role. FINDINGS: Except for Parental Mutuality, family management ratings were not significantly different for mothers and fathers, and parental views of survivors' physical and emotional QOL improved with better family management. Parental role moderated associations between physical and emotional QOL and Survivors' Daily Life and between emotional QOL and Condition Management Ability, Condition Management Effort, and View of Condition Impact. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: Assess and address survivor QOL through family management from multiple perspectives.

Breast Cancer Survivorship Experiences of Urban Hispanic Women.

The purpose of this study was to explore determinates of health that impact survivorship of urban Hispanic breast cancer survivors who are at risk for experiencing poorer outcomes than others. Some challenges have been characterized, but gaps in our knowledge of the impact of some of the social determinates of health remain. Challenges likely exist prior to a diagnosis of cancer and may amplify in intensity during survivorship, potentially shortening survival and quality of life of these women. A narrative, focus group was conducted with a group of urban Hispanic breast cancer survivors. A series of linked vignettes describing survivorship challenges and late effects of breast cancer pathology and treatment were used to stimulate discussion. Three themes impacting survivorship were identified. The themes included communication (health literacy), isolation, and social support and financial cost. Communication issues resulted in delays in treatment denial of services. While these themes in cancer survivors are independent of residence (rural, suburban, or urban) and across ethnic groups, some unique issues were identified in urban Hispanic breast cancer survivors. Members of the healthcare team are in a unique position to enhance survivor's health literacy, advocate for programmatic efforts to enhance navigation roles in the hospital and communities, decrease delays in initiating care, and decrease the rate of patients lost.

Adaptive Modeling: An Approach for Incorporating Nonlinearity in Regression Analyses.

Although regression relationships commonly are treated as linear, this often is not the case. An adaptive approach is described for identifying nonlinear relationships based on power transforms of predictor (or independent) variables and for assessing whether or not relationships are distinctly nonlinear. It is also possible to model adaptively both means and variances of continuous outcome (or dependent) variables and to adaptively power transform positive-valued continuous outcomes, along with their predictors. Example analyses are provided of data from parents in a nursing study on emotional-health-related quality of life for childhood brain tumor survivors as a function of the effort to manage the survivors' condition. These analyses demonstrate that relationships, including moderation relationships, can be distinctly nonlinear, that conclusions about means can be affected by accounting for non-constant variances, and that outcome transformation along with predictor transformation can provide distinct improvements and can resolve skewness problems.© 2017 Wiley Periodicals, Inc.

Utilizing health records to characterize obesity, comorbidities, and health-care services in one human service agency in the United States.

US surveys report higher prevalence of obesity in adults with intellectual disability. Health records of 40 adults with intellectual disability were retrospectively reviewed for data on health status, problem lists with International Classification of Diseases, Ninth Revision codes, medication lists, and health encounters over 18 months. Mean age was 49.5 years, 53% were males. Prevalence of overweight, obese, and morbidly obese was 28%, 58%, and 23%, respectively. Primary diagnosis was intellectual disability (50% mild, 33% moderate, 10% severe, and 8% profound), 85% had mental health disorders (67.5% with affective or mood and 42.5% had anxiety disorders). On average, residents consumed 2.63 psychotropic medications daily with additional 5.75 medications for axis 3 diagnoses and made 39.2 health visits over past 18 months. Our analysis supports increased prevalence of overweight/obesity, higher comorbidities, dual psychiatric diagnosis, substantial medication consumption, and higher utilization of health-care services in adults with intellectual disabilities. Targeted health interventions are therefore essential to improve their health and quality of life.

Indicators of Health Literacy In Bladder Cancer Survivors: A Secondary Analysis of the Integrative Health Interview Series (IHIS).

A secondary analysis was performed to characterize the health literacy of bladder cancer survivors. A cluster of patients was identified that is less healthy and may have more health literacy needs.

Cognition in breast cancer survivors: hormones versus depression.

OBJECTIVE: Breast cancer survivors receiving hormone treatment and/or endorsing histories of receiving chemotherapy report changes in their cognitive capacity, which is often not supported by formal testing. To address these conflicting reports, this study examined survivors' applied cognitive capacity and its association with hormone treatment, depression, and selected demographics. METHODS: A descriptive, correlational, cross-sectional survey design was employed. There were 357 women who completed a survey comprised of 69 questions. The survey included both investigator-developed questions and instruments from the PROMIS(®) system. RESULTS: There were significant main effects for hormone therapy, race, and depression. Depression explained the largest portion of variance of the perceived decreases in cognitive function among breast cancer survivors. CONCLUSIONS: Survivor complaints of changes in cognitive function may be a predictor for evaluating the presence of mood disorders and less a function of hormone therapy or chemotherapy history.

Health-related quality of life of adolescent and young adult survivors of childhood brain tumors.

OBJECTIVE: Our aim was to expand research on predictors of health-related quality of life (HRQOL) for adolescent and young adult survivors of childhood brain tumors who are not living independently by evaluating the mediating role of family functioning in the association of disease severity/treatment late effects with survivor self-report and caregiver-proxy report of physical and emotional HRQOL. METHODS: Mothers (N = 186) and their survivors living at home (N = 126) completed self-report and caregiver-proxy report of physical and emotional HRQOL. Mothers completed family functioning measures of general family functioning, caregiving demands, and caregiver distress. Medical file review and caregiver report were used to evaluate disease severity/treatment late effects. RESULTS: Using structural equation models, family functioning was adjusted for sociodemographic factors. Disease severity/treatment late effects had significant direct effects on self-report and caregiver-proxy report of physical and emotional HRQOL. Family functioning had a significant direct effect on caregiver-proxy report of physical and emotional HRQOL, but these findings were not confirmed for self-report HRQOL. Model-fit indices suggested good fit of the models, but the mediation effect of family functioning was not supported. CONCLUSIONS: Disease severity/treatment late effects explained self-report and caregiver-proxy report of physical and emotional HRQOL for these adolescent and young adult survivors of childhood brain tumors. Family functioning was implicated as an important factor for caregiver-proxy report only. To enhance physical and emotional HRQOL, findings underscore the importance of coordinated, multidisciplinary follow-up care for the survivors who are not living independently and their families to address treatment late effects and support family management.

Characterising emergency department high-frequency users in a rural hospital.

OBJECTIVE: Patients who are frequent users (≥4 visits/year) comprise ∼10% of patients, but account for ∼34% of total yearly emergency department (ED) visits. Non-emergent care provided to frequent ED users affects operating costs and usage. The majority of reports characterising frequent ED use are from urban teaching centres. This study describes frequent users of ED services in a rural community setting and the association between counts of patient's visits and discrete diagnoses. DESIGN: Retrospective study of 1652 frequent ED adult patients from a rural US hospital over a one-year period. Descriptive statistics and Poisson regression were used to explore the characteristics of frequent users and their patterns of diagnoses. RESULTS: Frequent user visits ranged from 4 to 66 per patient. Frequent users were 9.41% of patient volume accounting for 33.94% of the total visits and were younger compared with patients with <4 visits. Approximately 36% of frequent user visits were generated by 20 diagnoses when the diagnoses were concatenated into domains which covered ∼76% of the visits. There was a high correlation between the number of visits and discrete diagnoses in frequent users. CONCLUSIONS: These findings suggest a more complex picture of rural ED services and their relationship with primary care and dental services, which needs to be defined before policy development to reduce ED use.

Warfarin use post hospitalization: pilot comparative effectiveness of telephone follow-up.

PURPOSE: This study's aims were to evaluate patient knowledge of safe warfarin practices early in treatment, and to pilot a nursing telephone follow-up enhancement to a pharmacy-facilitated discharge. METHOD: Forty-two randomized patients in either "enhanced follow-up" or "treatment as usual" groups completed the study. RESULTS: Enhanced treatment resulted in significant improvement in warfarin knowledge (86% versus 71%). In critical safety related knowledge questions even larger improvements were present (∼96% compared to ∼77%). DISCUSSION: The hypothesis that non-adherence generating rehospitalization is a function of poorer knowledge was not supported as there were no warfarin-related readmissions during the study. CONCLUSION: The study supports the use of enhanced follow up and the need for larger studies to delineate what patient knowledge prevents rehospitalization and cost effective educational efforts.

Experiences of Asian Women Who Live in Urban Environments and Are Breast Cancer Survivors.

INTRODUCTION: Despite expanding interest in cancer survivorship, little is known about urban Asian breast cancer survivors whose experience may differ from those in suburban and rural locations. This study explores survivors' challenges to maximize outcomes and identify common and unique themes among urban Asian survivors. Information was obtained from the survivors and outreach workers from their community. METHODOLOGY: Descriptive qualitative methods including semistructured interview guides were used to plan, conduct, and analyze both individual interviews of Asian women (n = 6) and a focus group (n = 7) composed of community outreach workers. RESULTS: The interview and focus group findings, endorsed themes of communication/language, trust, and privacy, with generational differences. Poor health literacy in both survivors and providers was identified. DISCUSSION: Nurses are in a unique position to use the themes identified to both assist survivors expand their health literacy and lobby for resources for providers to promote culturally congruent care.

Level of pain and waiting time in the emergency department.

Pain is the leading reason individuals seek emergency care. Studies have concluded that acute pain conditions are underevaluated and undertreated in the emergency department (ED). There is a paucity of information about how the severity of pain influences the time spent in the ED before being seen by a physician. Therefore, this study focuses on what role pain plays regarding time to treatment in the ED, i.e., to examine the effects of patients' perceived level of pain on wait time in the ED. The CDC's National Hospital Ambulatory Medical Survey 2003 data were used in this study. The sample consisted of 12,860 caucasians and African Americans with a mean age of 44.52 years. Analysis of covariance was used to explore differences in length of waiting time in ED based on race, triage nurses rating of the immediacy of the need to be seen by a physician, and the level of pain the patient reported. The findings showed that patients' reports of pain had very little effect on the length of waiting time. Given the sample size, we feel there is adequate power to detect the effect of pain in determining the length of waiting time to see a physician if it were present. In addition, African Americans had a statistically significant longer wait (15.29 minutes) than Whites. The effect of race might be interpreted as another example of health disparities or could be a hospital-level effect which was not examined within this model.

Cancer Screening and Prevention in Lesbian, Gay, Bisexual, and Transgendered Community and Asian Lesbian, Gay, Bisexual, and Transgendered Members.

Participation in cancer screening and prevention (cessation of or reduction in modifiable health risk behaviors) are the most effective methods of reducing cancer morbidity and mortality. Some members of the lesbian, gay, bisexual, and transgendered (LGBT) communities have not participated in screening for a variety of reasons which have been explored in the literature. Common and unique behavioral risks are also reviewed. Knowledge about Asian members of the LGBT community participation in cancer screening and prevention is limited. This paper reviews the current literature on participation and barriers to cancer screening and prevention for the LGBT community and provides some insights for the Asian LGBT subcommunity. Potential interventions that have been demonstrated to be effective are presented for potential implementation within nursing practice and practice settings. Suggestions for future research are also provided to enhance the care of the LGBT community.

Patterns of Alcohol Abstinence in Mexican Women Residing in the United States: Effects of Nativity and Duration in the United States.

OBJECTIVES: Explore changes in abstinence rates in Mexican women (MW) residing in the United States based on nativity and time in the United States as an indicator risks for future alcohol-related disorders. DESIGN: A secondary analysis of data from the National Health Interview Survey evaluated rates of abstinence between 2000 and 2017. A logistic regression was completed to address the impact of age, years in the United States, sample years. SAMPLE: A total of 29,860 MW surveyed over an 18-year period that included those born in and outside the United States. PRIMARY RESEARCH VARIABLES: Dependent variable was abstinence status; independent variables included nativity, year of survey, age, years in the United States (if immigrant). RESULTS: Immigrant MW showed higher rates of alcohol abstinence than U.S.-born MW across all years, but regardless of place of birth, fewer MW are abstaining over time. Among immigrant MW, those only in the United States greater than 15 years had a greater risk of becoming a drinker than those in the United States less than 5 years. CONCLUSION: There are declining rates of alcohol abstinence among MW regardless of immigration status. The lower rate of abstinent MW increases their risk for alcohol-related disorders. Assessing MW's use of alcohol and providing targeted education is essential.

Sex differences in the heritability of alcohol problems.

Genetic factors may have a role in defining more coherent clinical phenotypes and subtypes in the DSM-V. Research has demonstrated that there are gender differences in the patterns of alcohol consumption, specific symptom endorsement, withdrawal effects, and rates of alcohol use disorders (AUD). We examined the sex-specific heritability of diagnostic symptoms for alcohol-related problems in a community-based sample of twin pairs (males: n = 519; females: n = 613) using a biometrical analytic strategy to estimate the genetic and environmental components of AUD symptoms. Five of the seven symptoms of alcohol problems demonstrated sex-differences in heritability. Three of the seven symptoms examined had significant heritability in female twins only: "increased risk of injury or harm," "emotional problems related to drinking," and "the desire to drink." In males, a different pattern was observed, with four of the seven examined symptoms demonstrating heritability: "Increased chance of injury or harm," "spending more time using alcohol or getting over its effects," "using larger amounts for longer periods of time than intended," and "the need to use more alcohol to get the same effect." These data suggest that alcohol problems in females and males may be etiologically distinct, and that diagnostic criteria and therapeutics might be enhanced if these sex differences were taken into consideration.

Lesbians' disclosure of sexual orientation and satisfaction with care.

The overarching aim of this study was to explore demographic variables and their association with a woman's disclosure of sexual orientation to a health care provider (HCP). This descriptive correlation study used a convenience sample of 96 women recruited at gay and lesbian community events held in Delaware. A self-report survey of 35 questions was used to obtain the data. None of the women identified themselves as exclusively heterosexual. The results indicate that a woman's self-identified sexual orientation is significant in predicting whether she has shared her orientation with her HCP. The more a woman's self-reported orientation moves toward the heterosexual end of the preference scale, the less likely she is to share her orientation with her HCP. Culturally competent care and a nondiscriminatory atmosphere will provide this population with the trust needed to enable open rapport with their HCPs.

Are college students told by health care providers about their risk factors for developing diabetes?

BACKGROUND AND PURPOSE: Communication about risk factors for diabetes between nurse practitioners and college students may not be occurring as the prevalence of Type 2 diabetes increases. The purpose of this secondary analysis was to evaluate if college students are being told of their risk for diabetes based on known risk factors of weight, sleep, and depressive symptoms. METHODS: Descriptive, cross-sectional study was completed using National Health and Nutrition Examination Survey 2011-2012. Using listwise deletion for all variables in the analyses, the sample (N = 313) included college participants aged 18-25 years. Logistic regression model found that body mass index (BMI), sleep quantity, and gender were significant predictors of not being told one was at risk for diabetes. In those with a BMI >25 kg/m (n = 159), only 22% were told about their risk for diabetes by a health care provider. CONCLUSIONS: Nurse practitioners may not be recognizing the factors that affect on the development of prediabetes in college-age students or not providing guidance for measures to prevent the morbidity related to diabetes. IMPLICATIONS FOR PRACTICE: Nurse practitioners are in a prime position to identify individuals with overweight/obesity, poor sleep, and depressive symptoms and recommend lifestyle changes to prevent the onset of disease.

Patterns of family management for adolescent and young adult brain tumor survivors.

Little is known about how families systemically incorporate the work of caring for adolescent and young adult (AYA) survivors of childhood brain tumors who often remain dependent on their families well into adulthood. The primary aim of this study was to develop a typology of family management (FM) patterns for AYA survivors. The secondary aims were to compare them with FM patterns previously described for children with chronic health conditions and to validate the patterns using quantitative and qualitative data. Guided by the Family Management Styles Framework, a sequential, mixed-methods design was used to gather quantitative data from 186 mothers (primary caregivers) and 134 AYA survivors. FM patterns (family focused; somewhat family focused; somewhat condition focused; and condition focused) were identified using cluster analysis of data from the Family Management Measure. FM patterns were found to be similar to those for children with chronic health physical conditions and were significantly related to maternal quality of life, survivor quality of life (health-related quality of life [self- and mother proxy report]), cancer-related variables (treatment intensity, medical late effects), and family functioning in theoretically meaningfully ways. Significant demographic characteristics included private insurance and AYA survivors' engagement in school or employment. Qualitative analysis of data from 45 interviews with mothers from the larger sample provided additional support for and elaborated descriptions of FM patterns. Identification of FM patterns moves the science of family caregiving forward by aggregating data into a conceptually based typology, thereby taking into account the complex intersection of the condition, the family, and condition management. (PsycINFO Database Record

Diplotypes of the human serotonin 1B receptor promoter predict growth hormone responses to sumatriptan in abstinent alcohol-dependent men.

BACKGROUND: Some studies have associated alcohol dependence (AD) with the human serotonin (5-HT)(1B) receptor (HTR1B). This investigation explored the functional responsivity of HTR1B in abstinent AD men using a sumatriptan challenge, while measuring genetic heterogeneity in the HTR1B promoter. METHODS: Abstinent AD men (n = 27) and abstinent men without any alcohol use disorder (n = 19) were administered 6 mg of sumatriptan succinate, subcutaneously. Plasma samples collected over the following 2 hours were assayed for growth hormone (GH) concentrations. His DNA was genotyped for the A-161T and T-261G polymorphisms of the HTR1B promoter and diplotypes determined. RESULTS: Integrated GH responses were predicted by interactions of AD and promoter diplotypes, as well as subject ethnicity. The final model accounted for nearly 35% of the variance in GH responses. Post hoc evaluation revealed that AD was associated with a blunting of GH secretion only among individuals with the most common HTR1B diplotype (TT/TT). CONCLUSIONS: A blunting of GH responses in abstinent AD men was observed only among those with the most common HTR1B promoter diplotype. Less common promoter diplotypes appeared protective. Controlling for genetic background is a useful augmentation of case-control pharmacological challenge strategies designed to elucidate the psychobiology of AD and other complex disorders.

Changing HPV vaccination rates in bisexual and lesbian women.

BACKGROUND: Human papillomavirus (HPV) vaccination rates continue to be below national targets for women and lower in some sexual minorities. HPV is a primary causal agent in cervical cancer, from which members of the lesbian and bisexual community mistakenly believe they are at low risk. This study characterized rates of HPV vaccination in women based on their sexual orientation. METHODS: Data were obtained from the Centers for Disease Control and Prevention's National Health Interview Survey 2013-2014. This survey evaluated 5695 women-113 (2%) lesbian, 135 (2.4%) bisexual, and 5446 (95.6%) heterosexual women ages 18-26 in 2006-using logistic regression. A dependent variable of having had HPV vaccination and independent variable of sexual orientation was used. RESULTS: Significant differences were found in vaccine uptake based on sexual orientation. Bisexual women were most likely to be vaccinated, and differed significantly from heterosexual and lesbians which did not differ significantly from each other. The results suggest improvement in sexual minority rates but this finding is tempered by the low rates of vaccination in adult women. IMPLICATIONS: The low vaccination rates in adult women and sexual minorities merit further study. The low rates may be a function of the transition from pediatric to adult care and/or practice barriers perceived by sexual minorities.

Genetic correlations between smoking initiation and smoking behaviors in a twin sample.

Early exposure to cigarettes is connected to increasing rate of regular use later in life. We examine genetic correlation between the age of first cigarette and later smoking related behaviors. The sample consisted of twin ages 25 to 75. Biometrical analysis was used to evaluate the heritabilities and a second analyses based on Cholesky decomposition determined the shared variance. The genetic variance ranged from 48% to 69%. Models comparing age of first cigarette to and smoking persistence, cessation, and number of cigarettes during year smoked most individually indicated a very small proportion of shared genetic variance (ranging from 0.004 to 0.056). These findings support separate genetic and unshared environmental processes for the age of first cigarette as compared to three other smoking related phenotypes. Research in substance abuse risk and prevention literature suggests that delaying initial exposure is a critical step reducing in the risk of later regular use. The interventional implications of the findings support the importance of a tailored approach to preventing smoking behavior and reducing harm in smokers.