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.

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.

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.

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.

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.

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.

Association of parental smoking behaviors and absences in school-age children: implications for the nurse practitioner.

PURPOSE: To examine the association between reported absences and parental smoking in school-age children, aged 6-17, and to specifically explore the impact of maternal smoking on the health and attendance of school-age children. DATA SOURCES: The sample of 7488 parent-child dyads was randomly selected from the 2002 National Health Interview Survey, a multipurpose cross-sectional household interview survey conducted by the Centers for Disease Control and Prevention. The parent sample included 2673 men and 4375 women. Children's ages ranged from 6 to 17 with a mean of 11.7 years. CONCLUSIONS: Maternal, but not paternal, present and past smoking behavior significantly impacts the child's wellness and school attendance. The reasons for this disparity are unclear but may relate to synergistic effects of pre- and postnatal nicotine exposure, the traditional role of mother as caregiver, or specific smoking habits that increase environmental tobacco exposure. IMPLICATIONS FOR PRACTICE: Assessment and educational strategies for families regarding the hazards of childhood exposure to environmental tobacco smoke are indicated. Specific implications for the role of the nurse practitioner across diverse specialties are addressed with emphasis on the need for development of gender, age, and culturally sensitive smoking cessation programs and support networks.

Family Functioning Mediates the Association Between Neurocognitive Functioning and Health-Related Quality of Life in Young Adult Survivors of Childhood Brain Tumors.

PURPOSE: Childhood brain tumor (BT) survivors experience significant neurocognitive sequelae that affect health-related quality of life (HRQOL). A model of neurodevelopmental late effects and family functioning in childhood cancer survivors suggests associations between survivor neurocognitive functioning, family functioning, and survivor HRQOL. This study examines the concurrent associations between survivor neurocognitive functioning, family functioning, and survivor emotional HRQOL, and the indirect effects of neurocognitive functioning on survivor emotional HRQOL through family functioning. METHODS: Participants included young adult-aged childhood BT survivors (18-30 years old; N=34) who were on average 16 years post-diagnosis, and their mothers. A brief neuropsychological battery assessed working and verbal memory, processing speed, and executive functioning. Survivors and mothers completed measures of family functioning, and mothers completed a proxy-report measure of survivor HRQOL. RESULTS: Spearman bivariate correlations examined the associations between indices of survivor neurocognitive functioning and concurrent family functioning and survivor emotional HRQOL. Poorer survivor processing speed, working memory, verbal memory, and executive function were significantly associated with worse survivor- and mother-reported family functioning (r's range: 0.36-0.58). Additionally, worse survivor processing speed and executive function were significantly associated with poorer survivor emotional HRQOL (r's range: 0.44-0.48). Bootstrapping analyses provided evidence for the indirect effects of neurocognitive functioning on survivor emotional HRQOL through family functioning. CONCLUSION: These findings suggest that family functioning is an important variable that might mitigate the negative influence of neurocognitive late effects on survivors and is a potential target in future interventions.

Assessing Suicidal Ideation and Behaviors Among Survivors of Childhood Brain Tumors and Their Mothers During Sociobehavioral Research.

PURPOSE/OBJECTIVES: To describe the development and feasibility of a protocol for nonpsychiatric subspecialty research staff members to screen research participants who endorse suicidal ideations or behaviors during data collection
. DESIGN: Descriptive protocol development.
. SETTING: The Children's Hospital of Philadelphia and the University of Pennsylvania.
. SAMPLE: 186 mother caregivers and 134 adolescent or young adult survivors of childhood brain tumors, with the protocol implemented for 5 caregivers and 11 survivors. METHODS: During telephone- and home-based interviews, the interviewer assessed the participant using the Columbia-Suicide Severity Rating Scale (C-SSRS). MAIN RESEARCH VARIABLES: Expressed suicidal ideation or behavior
. FINDINGS: Implementation of the C-SSRS by nonpsychiatric subspecialty staff members was feasible and valid. Interviewers' conclusions based on this instrument matched those of the mental health professional who followed up with participants. Process notes contained themes about the participants, including anger and sadness in survivors and the physical and emotional demands of the survivor in caregivers. Progress notes for the interviewer included a reiteration of events, whether the assessment was successful, and whether the recommendation of the interviewer was in agreement with that of the mental health professional
. CONCLUSIONS: The protocol based on the C-SSRS was useful and feasible for nonpsychiatric subspecialty staff members to use in the collection of data from survivors of childhood brain tumors and their caregivers. IMPLICATIONS FOR NURSING: Survivors of childhood brain tumors and their caregivers may experience psychosocial distress. Nurses, as research assistants or in other roles, can use tools such as the C-SSRS to assist in front-line assessments. 
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Family functioning and peer affiliation in children of fathers with antisocial personality disorder and substance dependence: associations with problem behaviors.

OBJECTIVE: Family functioning and peer influences are theoretically linked to child psychopathology. This study quantified the functional status of families with fathers with substance dependence with or without comorbid antisocial personality disorder and evaluated the peer environments of preadolescent offspring. The authors examined associations between the child's psychopathology, paternal substance dependence/antisocial personality disorder status, and measures of family and peer environments. METHOD: Families with the presence or absence of paternal substance dependence were subdivided into those with and without paternal antisocial personality disorder. Grouped families were contrasted on measures of family functioning, the child's peer affiliation, and the child's problem behaviors. Regression analysis determined the influence of these factors on the child's psychopathology. RESULTS: Families with paternal substance dependence functioned worse than normal comparison families. However, families with paternal substance dependence and antisocial personality disorder (N=34) did not differ markedly from those with substance dependence without antisocial personality disorder (N=84). The children of fathers with both substance dependence and antisocial personality disorder had greater affiliation with deviant peers than those with substance dependence without antisocial personality disorder and comparison families (N=104). CONCLUSIONS: Children of fathers with substance dependence and antisocial personality disorder demonstrated higher externalizing and internalizing psychopathology than those with substance dependence but not antisocial personality disorder and those without either condition. Paternal substance dependence/antisocial personality disorder status and the child's affiliation with deviant peers were most robustly associated with the child's psychopathology. Research is needed to develop interventions that effectively address parental risk and healthy peer relations.

Affiliation with deviant peers among children of substance dependent fathers from pre-adolescence into adolescence: associations with problem behaviors.

OBJECTIVE: Affiliation with delinquent peers has been shown to be a major risk factor for the development of antisocial and substance abuse behaviors in adolescence. However, little data are available concerning the developmental trajectories of deviant peer affiliation. METHOD: In this study, we have prospectively examined the density of deviant peers among the social networks of children of drug dependent fathers at age 10, and at 2 and 5 year follow-ups, and compared them with those of controls. Measures of internalizing and externalizing psychopathology were employed as time varying covariates, while socioeconomic status (SES) was used as a time invariant covariate. A pattern mixture analysis of missing data was conducted. RESULTS: Using mixed effects models, we found significant main effects of time, group, externalizing psychopathology, and to lesser extent, SES on the magnitude of affiliation with deviant peers. Greater deviant peer affiliation among the high-risk children was found at each time point. Externalizing psychopathology augmented the magnitude of deviant peer affiliation in both high-risk and comparison children. CONCLUSION: Offspring of drug dependent fathers have heightened affiliation with deviant peers from pre-adolescence through mid-adolescence. This social developmental process may be a component of the familial risk for substance abuse and antisocial behaviors.

Does adverse family environment or sex matter in the salivary cortisol responses to anticipatory stress?

We previously reported that in anticipation of a modest stressor, preadolescent sons of drug-dependent fathers (HR) demonstrated a diminished salivary cortisol response relative to comparison boys. No data were available concerning anticipatory salivary cortisol responses in preadolescent daughters of HR fathers. Additionally, we hypothesized that diminished stress responses in HR youth might be an adaptation to a stressful family environment. Consequently, in this report we have examined the role of family environment in the anticipatory salivary cortisol responses in both HR boys and girls as well as their association with a measure of distress in the family environment. Independent of sex, HR children had diminished anticipatory cortisol responses. Girls had significantly higher salivary cortisol concentrations, pre- and post-stressor. However, contrary to our expectation, we could not demonstrate an association between salivary cortisol responses and the measures of the family environment. These results suggest that there may be a sex difference in salivary cortisol dynamics in preadolescent children; however, the functional status of the current family environment does not appear to be related to cortisol reactivity.

Sensory stimuli as obstacles to emergency care for children with autism spectrum disorder.

Visits to the emergency department (ED) are stressful for any patient and pose special challenges and potential barriers to care for those with autism spectrum disorder (ASD). In addition, people (both children and adults) with ASD differ in their perception of, or responses to, environmental stimuli. Some people with ASD present with sensory defensiveness that is environmentally moderated, but there is a gap in our knowledge about patterns or thresholds of stimulation that kindle behavioral responses. We systematically recorded visual and auditory stimuli in an ED. Data were collected in four areas, hallway, doorway of waiting room, chair in waiting room, and treatment room, over several weeks and times of day. The mean light intensity ranged from 127 to 184 lux. There were significant differences (F = 16.77, df = 3, p > 0.001) between the five ED locations. Mean sound levels ranged from a high of 63.291 dB in the waiting room chair to a low of 51.289 dB in the treatment room. The highest consistent level of noise was recorded while sitting in the waiting room chair (60.657-63.291 dB). The findings suggest significant differences in light and sound intensity in common ED locations, with the highest mean readings of light and noise in the waiting areas. The differences and descriptions of light and sound patterns support the need for additional studies in both the measurement of the ED environment and its role in stimulating sensory defensiveness in people with ASD.

Drinks per day in women of Mexican origin: does birth place matter?

Historically, Mexican-born women who immigrate to the United States (U.S.) have lower levels of alcohol use and higher rates of abstinence compared with Mexican American women born in the U.S. and other racial groups in the U.S. As such, immigrant women's alcohol use has received limited attention by the research community. Gaps in knowledge of their alcohol use patterns, changes in healthy drinking recommendation for women, and projections of population growth in both Mexican immigrant and Mexican American populations support the need for the study. Data from the Center for Disease Control's National Health Interview Survey were used to explore alcohol use differences in women of Mexican origin born in and outside of the U.S. In addition, the relationship between years in the U.S. and drinks per day was explored in Mexican immigrant women. The results indicated that Mexican immigrant women who drink are drinking above recommended levels and the younger immigrant women are drinking more drinks per day than young Mexican American women. These changes point to the importance of developing culturally sensitive interventions for this expanding segment of the population.

What's age got to do with it? Partner age difference, power, intimate partner violence, and sexual risk in urban adolescents.

Adolescent girls with older male main partners are at greater risk for adverse sexual health outcomes than other adolescent girls. One explanation for this finding is that low relationship power occurs with partner age difference. Using a cross-sectional, descriptive design, we investigated the effect of partner age difference between an adolescent girl and her male partner on sexual risk behavior through the mediators of sexual relationship power, and physical intimate partner violence (IPV), and psychological IPV severity. We chose Blanc's framework to guide this study as it depicts the links among demographic, social, economic, relationship, family and community characteristics, and reproductive health outcomes with gender-based relationship power and violence. Urban adolescent girls (N = 155) completed an anonymous computer-assisted self-interview survey to examine partner and relationship factors' effect on consistent condom use. Our sample had an average age of 16.1 years with a mean partner age of 17.8 years. Partners were predominantly African American (75%), non-Hispanic (74%), and low-income (81%); 24% of participants reported consistent condom use in the last 3 months. Descriptive, correlation, and multiple mediation analyses were conducted. Partner age difference was negatively associated with consistent condom use (-.4292, p < .01); however, the indirect effects through three proposed mediators (relationship power, physical IPV, or psychological IPV severity) were not statistically significant. Further studies are needed to explore alternative rationale explaining the relationship between partner age differences and sexual risk factors within adolescent sexual relationships. Nonetheless, for clinicians and researchers, these findings underscore the heightened risk associated with partner age differences and impact of relationship dynamics on sexual risk behavior.

Associations among depressive symptoms, dating violence, and relationship power in urban, adolescent girls.

OBJECTIVE: To explore the associations among dating violence (DV), aggression, relationship power, and depressive symptoms. DESIGN: A cross-sectional survey secondary analysis. SETTING: An urban, school based health center, October, 2009 through May, 2009. PARTICIPANTS: Low income, adolescent girls (n = 155), ages 14-18. METHODS: Descriptive and bivariate analyses were conducted to illustrate patterns and associations among variables. Key variables included depressive symptoms, DV victimization and aggression, and relationship power. We used mediation analyses to determine the direct and indirect effects among variables. RESULTS: Both DV victimization and aggression were reported frequently. Furthermore, DV victimization had a significant direct effect on depression and an indirect effect through relationship power. Depressive symptoms and relationship power were associated with DV aggression. Although relationship power did have a significant inverse effect on depressive symptoms, it was not through DV aggression. CONCLUSIONS: Complex associations remain between mental health and DV; however, relationship power partially accounts for DV victimization's effect on depressive symptoms. Depressive symptoms are associated with DV victimization and aggression; therefore, nurses should address relationship power in clinical and community interventions.

The genetics of substance abuse.

Substance abuse is among the most prevalent psychiatric disorders in males and contributes significantly to the morbidity and mortality nurses see in practice. Substance use and abuse disorders were the cause of a half million drug-related visits to emergency rooms in 1995, with more than 50% related to drug overdoses. Substance abuse and dependency result from a complex interaction of genetics and the environment. Various polymorphisms of genes have been demonstrated to have either protective effects or increased risk associated with their presence. Substance abuse is a chronic disease state that has effective treatments that reduce drug use, crime, and psychosocial problems. Nurses can provide targeted education and interventions to positively impact substance abuse treatment and by applying basic principles of genetic counseling may prevent transmission to future generations.