QT dispersion is reduced after valve replacement in patients with aortic stenosis.

OBJECTIVE: To investigate whether QT dispersion is a reliable index of the severity of aortic stenosis and left ventricular hypertrophy in the setting of aortic stenosis. DESIGN: A retrospective analysis of the results of echocardiography and electrocardiography before and after aortic valve replacement. SETTING: Tertiary centre. PATIENTS: 36 men (30 white and six black) with symptomatic aortic stenosis requiring valve replacement. RESULTS: All patients had significant aortic stenosis (mean (SD) aortic valve area 0.68 (0.18) cm2) and evidence of left ventricular hypertrophy (left ventricular mass index (LVMI): 267 (90) g/m2). Before aortic valve replacement, QT dispersion was correlated with mean aortic valve area and LVMI (r = 0.697, p < 0.001, and r = 0.59, p < 2.4 x 10(-6), respectively). QT dispersion and QT corrected for heart rate dispersion decreased from 133 (54) to 71 (33) ms and from 151 (64) to 94 (76) ms, respectively (p < 0.001 for both). LVMI regressed after aortic valve replacement to 190 (79) g/m2, p < 0.01. CONCLUSIONS: QT dispersion is increased in association with LVMI in patients with significant symptomatic aortic stenosis. Aortic valve replacement reduces QT dispersion and LVMI. QT dispersion could be a useful indicator of risk and risk reduction in patients with significant symptomatic aortic stenosis.

Effects of a home-based family intervention on adolescent alcohol use and misuse.

OBJECTIVE: Systematic evaluation of theoretically and empirically based family programs to prevent adolescent alcohol use/misuse is limited. Data presented here are from a longitudinal study evaluating a home-based universal adolescent alcohol use prevention program. The intervention was designed to enhance protective factors and minimize risk factors identified as influencing adolescent alcohol use. METHOD: A randomized pretest/posttest repeated measures design was used. Adolescents (N = 428; 54% females, 86% European American) and their parents were recruited from three Midwestern school districts. Families were randomly assigned to either a three-session family intervention or a no-intervention control condition. Pretest data collection and the intervention occurred when the adolescents were in fourth grade, and a booster intervention was given in seventh grade. Posttest data collection was completed each year for 4 years in the classroom for adolescents. RESULTS: The intervention was associated with a reduction in alcohol use (F = 5.16, 4/421 df, p < .001) and misuse (F = 3.08, 4/421 df, p < .05) for those adolescents in the intervention condition who were not using alcohol prior to the initiation of the program, but not for those who were using alcohol before initiation of the program. CONCLUSIONS: The results support the possible effectiveness of the family intervention as a universal prevention program for decreasing initiation of alcohol use and subsequent misuse for the majority of adolescents who do not report prior drinking. However, additional intervention approaches appear necessary for adolescents who have already used alcohol.

Older women and mammography screening behavior: do possible selves contribute?

This study sought to explore the contribution of the self-concept to older women's adherence to regular mammography screening behavior. The PRECEDE and health belief model concepts were incorporated with a measure of the women's future selves to determine whether the self-concept adds to our ability to predict screening. A self-administered questionnaire was completed by 210 community-dwelling women ages 50 to 75 years, recruited from urban and rural women's groups. Logistic regression analyses revealed that predictors of adherence were clinical breast examination, physician recommendation, age, barriers, benefits, feared health-related possible self, and self-efficacy in the feared domain. The addition of the self measures significantly improved the overall fit of the model. Implications for theory development, practice, and future research are discussed.

Family interventions to prevent substance abuse: children and adolescents.

Substance abuse often begins in adolescence and is a major factor determining health outcomes for adolescents and adults; thus, it is an important focus for prevention strategies. The use of drugs, especially alcohol, can lead to chronic addiction to substances as well as contribute to a number of common chronic conditions. These conditions include cancer, cardiovascular disease, disability from accidents or violence, and unplanned pregnancy and are major causes of morbidity and mortality among adolescents and adults. As the major social unit responsible for socialization of children and stabilization of adult personalities, the family has been the target of prevention efforts. In this chapter the empirical literature on family interventions to prevent substance use in adolescents is critically reviewed, generalizations and implications for practice identified, and directions for future research projected.

Factors related to maternal employment status following the premature birth of an infant.

A sample of 110 two-parent families whose preterm infants were less than 37 weeks gestation, appropriate for gestational age, and free of major congenital anomalies were recruited from two level-III intensive care nurseries. At 3 months postpartum, 40 mothers (36.4%) were employed, 15 (13.6%) stated they were on a leave of absence, and the remaining 55 mothers (50%) were not employed. Although not significantly different on demographic or infant morbidity variables, employed mothers were significantly more employment-oriented and reported less choice and satisfaction with employment status than nonemployed mothers. In addition, employed mothers were employed more hours prenatally and reported prenatal plans to be employed sooner after the infant's birth than nonemployed mothers. Employed mothers also perceived more support from others for their employment and greater financial necessity and availability of child care than nonemployed mothers. Higher scores on employment orientation were correlated with higher maternal education level, fewer children, more hours employed, higher total support for their employment, higher financial necessity, and less choice and satisfaction with employment status.

Maternal employment effects on family and preterm infants at three months.

The purpose of this study was to investigate the effects of maternal employment status and the mother's degree of choice and satisfaction regarding her employment status on family functioning and on the preterm infant's development at three months chronologic age. Families with preterm infants (N = 110) were categorized as employed, nonemployed, and on leave of absence based on the mother's employment status at three months postpartum. There were no significant differences across employment groups on family functioning and child development. The infant's motor development was positively correlated with number of hours employed per week and degree of choice for the employed mother families, but negatively correlated with choice for the nonemployed mother families. These results suggest that maternal employment may not be detrimental for infants born prior to term. Indeed, it may be beneficial, especially if the mother has a choice in the matter.

Maternal employment effects on families and preterm infants at 18 months.

The purposes of this study were to investigate the effects of maternal employment, maternal employment attitude/behavior consistency, and degree of choice and satisfaction with the employment decision on family functioning and preterm infant development and to describe changes in family functioning over time. Data were collected in the family's home (N = 79) when the infant was 3, 9, and 18 months old. Parents in nonemployed-mother families were more satisfied with their families at 18 months than parents in employed-mother families. Decreases in family cohesion and/or adaptability from 9 to 18 months were seen for fathers in employed-mother families, for mothers in nonemployed-mother families, and for mothers in families where the mother's employment attitudes and behaviors were consistent. Degree of choice was positively related to the child's mental development, mother's perception of family cohesion, and mother's and father's satisfaction with family.

Data management issues in longitudinal research.

Much of the existing literature about the research process has neglected data management. While design, instrumentation, sampling, and analysis are important parts of the process, paying attention to the issues surrounding data management is crucial to the success of the study. Data entry and analysis are facilitated when the details of data structure and management are decided before data collection begins.

Maternal employment, family functioning, and preterm infant development at 9 and 12 months.

The purpose of this study was to investigate the effects of maternal employment on child development and family functioning for families with preterm infants. Data were collected in the family's home (N = 67) when the infant was 3, 9, and 12 months of age. Maternal employment at 3 months had little effect on 9- and 12-month child mental or psychomotor development or on family cohesion, adaptability, or satisfaction. Maternal employment attitude/behavior consistency was a significant predictor of psychomotor development. Choice in the employment decision at 3 months was positively related to both mental and psychomotor development at 9 and 12 months for nonemployed mothers.

Correlates of alcohol use and misuse in fourth-grade children: psychosocial, peer, parental, and family factors.

To determine level of alcohol use/misuse and to examine correlates of these behaviors, 1,314 fourth-grade students were surveyed. The questionnaire included 55 items concerning tolerance of deviance, deviant self-image, self-efficacy, susceptibility to peer pressure, personal and peer approval of alcohol use, peer adjustment, parent nurturance and monitoring, family adjustment, parental permissiveness, peer use of alcohol, and exposure to alcohol. The items were factor analyzed and indices constructed. The indices generally had acceptable alpha coefficients (alpha = .61-.91); two exceptions were peer adjustment (alpha = .51) and parental permissiveness (alpha = .42). Tolerance of deviance, deviant self-image, susceptibility to peer pressure, personal and peer approval, peer use and exposure by peers, and parental permissiveness were positively correlated with alcohol use/misuse. Self-efficacy, child-parent interactions, family adjustment, and peer adjustment were negatively correlated with alcohol use/misuse. Implications for the design of family-based alcohol use/misuse prevention programs are discussed.

A psychometric analysis of the Family Environment Scale.

Psychometric properties of the Moos (1979) Family Environment Scale (FES) were studied in a sample of 73 two-parent and 19 single-parent families. Mothers and fathers completed the FES questionnaire while the child in the family closest to 11 years old was administered the FES in an interview. Moos reported initial internal consistency estimates (Kuder-Richardson 20s) between .64 and .79. In this study, KR20s ranged from .24 to .75 for the entire sample, and differences among mothers, fathers, and children in the KR20s calculated for each group were found. Although Moos hypothesized three dimensions into which the 10 subscales fall, confirmatory factor analysis using LISREL VI did not support this assertion.