Carol E. Blixen

Values and beliefs about obesity and weight reduction among African American and Caucasian women

Designing culturally relevant weight-reduction programs requires understanding of ethnic variations and illness beliefs. Preliminary data on the values and beliefs about obesity and weight reduction were obtained from women of different ethnic/racial backgrounds. Purposive sampling was used to recruit African American (AA) and Caucasian (C) women with a body mass index (BMI)[.greaterequal] 30 from the general internal medicine clinics of a large tertiary care facility. Four focus groups (2 with AA women and 2 with C women) consisting of a total of 20 subjects were conducted in a 2-month period. AA women cited culture specific barriers to weight loss more so than did C women. AA women and C women also differed on how health care professionals could help them with weight loss. These findings have implications for nursings role in the design of culturally relevant weight-loss programs.

Dual diagnosis in elders discharged from a psychiatric hospital

Recent evidence indicates persons 60 years and over experience significant alcohol and substance abuse problems. Since a combination of alcoholism and depression is likely to increase the relative rsk of suicide, it is important to examine the prevalence of dual diagnosis in older adults. The purpose of this study is to examine the prevalence and correlates of dual diagnosis in older psychiatric inpatient populations and compare our results with findings from studies of younger hospitalized dually diagnosed patients. A retrospective chart audit was performed on 101 elders who were discharged from three psychiatric hospitals. Clinical variables that were examined included length of hospital stay, psychiatric and medical diagnoses, medications and history of suicidal ideation or intent. The leading psychiatric disorder diagnosis for our sample of hospitalized psychiatric elders was depression. Over one‐third (37.6%) had a substance abuse disorder in addition to a psychiatric disorder, and almost three‐fourths (71%) of this ‘dual diagnosis’ group abused alcohol and 29% abused both alcohol and other substances. In addition, significantly more elders in the ‘dual diagnosis’ group (17.7%) than in the group with only a mental disorder diagnosis (3.3%) made a suicide attempt prior to admission to the hospital. Because affective disorders in conjunction with alcohol abuse are the most frequently found disorders in completed suicides, our findings have important relevance for the advocating of routine use of diagnostic assessment and screening for both substance abuse and mental disorders in this population.

The Process and Outcome of Life Review Psychotherapy With Depressed Homebound Older Adults

The purpose of this study was to examine the process and outcomes of life review therapy provided by an advanced practice geropsychiatric nurse to older adults discharged from psychiatric hospitals to home health care. Eighty older adults over 65 years of age with a primary diagnosis of depression were treated at home for life review psychotherapy sessions (M = 13.24, SD = 8.65). Content analysis methods, both latent and manifest, were used to analyze the data and identify themes. Themes were classified as empowerment (connection, coping, efficacy, hope, and trust) or disempowerment (denial, despair, helpless, isolation, loneliness, and loss). Findings showed that, as a result of the life review therapy, there was a significant decrease (p < .0001) in total disempowerment themes (M1 = 13.07; M2 = 9.14).

Best Practices: Optimizing Care for People With Serious Mental Illness and Comorbid Diabetes

Diabetes and obesity among patients with serious mental illness are common. Use of second-generation antipsychotics compounds risk, and widely prevalent unhealthy behaviors further contribute to negative outcomes. This column describes Targeted Training in Illness Management, a group-based psychosocial treatment that blends psychoeducation, problem identification, goal setting, and behavioral modeling and reinforcement. The intervention has been adapted to the primary care setting and is targeted at individuals with serious mental illness and diabetes. A key feature of the intervention is the use of peer educators with serious mental illness and diabetes to teach and model self-management. Promising results from a 16-week trial are reported.

Feasibility of a Nurse-Run Asthma Education Program for Urban African-Americans: A Pilot Study

The objective of the study was to assess the feasibility of implementing and evaluating a culturally appropriate in-patient asthma education program specifically targeted for African-Americans. A consecutive sample of 28 African-American patients ages 18–50 who were hospitalized for asthma were randomized to an intervention group, which received three one-on-one sessions on chronic asthma management, or a control group, which received the usual care. Data on symptom frequency, self-management behaviors, quality of life, depression, and health care resource use were collected at baseline and at 3 and 6 months. Although the time required to recruit our sample took longer than anticipated, 28 subjects agreed to be in the study (70% acceptance rate) and complete the baseline interview. We observed no statistically significant differences from baseline or changing trends in frequency of asthma symptoms, self-management behaviors, and health care resource use between the intervention and control groups at 3 and 6 months. However, patients in the intervention group demonstrated a greater average increase in asthma-related quality of life and a greater average decrease in depression than the control group. Feasibility issues included shortened length of stay, which necessitated conducting all three self-management sessions together, multiple interruptions during the sessions, and retention issues at 3- and 6-month follow-ups. The lessons learned from this pilot study are invaluable in that they will enable us to make changes in our existing protocol to ensure the success of a larger clinical trial.

Public policy and adolescent pregnancy: A reexamination of the issues

In the United States 45% of female adolescents engage in premarital sex; 40% will become pregnant before reaching the age of 20; and 4/5 of these pregnancies will be unintended. Adolescent pregnancy has been associated with increased health risks for both the mother and the child. Only 6 in 10 adolescents will graduate from high school compared with 9 in 10 of their peers who delayed parenthood. The increasing number of single-parent families has contributed significantly to the increase in child poverty rates from 15% in 1960 to 20.3% in 1988. Further, such families cost billions of dollars to taxpayers because of public assistance and medical care. From a historical viewpoint the number of teen childbearing reached a peak in 1957 with 97.3 births per 1000 women 15-17 years old; it declined to 52.8/1000 by 1977 and to 51.8/1000 by the 1980s. The legalization of abortion in 1973 had a major impact on the resolution of adolescent pregnancies. Since the 1960s there has been a faster increase in early sexual activity, pregnancy, and birth among White adolescents than among minority groups. The United States has higher rates than western European countries, while it is also more ambivalent on sexuality issues. Tremendous change did take place in the 1960s in American culture as regards the family, and social and sexual relationships. Yet there is still a double standard with respect to female morality, and adolescents get a conflicting message about sexuality. Teenage mothers and their infants face an uncertain economic future because the much maligned welfare system is undergoing an overhaul and the market is shrinking for unskilled workers. Although increasing numbers of pregnant adolescents remained in school after amendments were passed to the education act, adolescent pregnancy has not been tackled at its very footing, its socioeconomic causes.

A comparison of asthma-related healthcare use between African-Americans and Caucasians belonging to a health maintenance organization (HMO).

The objective of this study was to determine whether racial differences in patterns of asthma care persist in a healthcare environment when financial barriers to health care are minimized. The study cohort consisted of African-American (AA) and Caucasian (C) patients, 18-50 years old, enrolled in a large HMO and hospitalized for asthma in 1993-1995. Baseline and 1-year follow-up data were collected from the HMO computerized database. Of the 193 patients in the cohort, 124 (65.3%) were AA and 67 (34.7%) were C. AAs were younger (mean = 36.2, SD = 9.9) than Cs (mean = 39.4, SD = 9.1), had a lower median household income, and made more asthma-related emergency department (ED) visits (45.2%) than Cs (22.4%) during the 1 year after the initial hospitalization (all p values <0.001). During the same time period, Cs made more asthma-related primary care (70.2%) and allergy/pulmonary visits (38.8%) than AAs (47.6% and 27%, respectively). Although there were no significant racial differences in the rehospitalization rate, AA Medicaid contract patients (32%) had more rehospitalizations for asthma than AA regular contract patients (15.8%). These differential patterns in the use of asthma-related healthcare in this study indicate that the provision of health insurance alone is not sufficient to promote optimal levels of asthma management by all beneficiaries. Asthma education programs targeted for low-income AA patients may improve inappropriate healthcare use patterns.

Alcohol Consumption Decisions Among Nonabusing Drinkers Diagnosed with Hepatitis C An Exploratory Sequential Mixed Methods Study

Most studies of decisions to curtail alcohol consumption reflect experiences of abusing drinkers. An exploratory sequential research design is used to explore the applicability of this research to the experience of nonabusing drinkers advised to curtail alcohol consumption after a hepatitis C diagnosis. A qualitative component identified 17 new decision factors not reflected in an inventory of factors based on synthesis of existing scales. Qualitative data were triangulated by supplementing semistructured interviews with Internet postings. A quantitative component estimated prevalence and association with current drinking of these new decision factors. Patients who quit drinking tended to attribute postdiagnosis drinking to occasional triggers, whereas patients who were still drinking were more likely to endorse rationales not tied to specific triggers.

A pilot study of health education via a nurse-run telephone self-management programme for elderly people with osteoarthritis.

We conducted a pilot study of a nurse-run telephone self-management programme for elderly people with osteoarthritis (OA). Thirty-two subjects, aged 60 years or more, with a diagnosis of OA were recruited from two hospital rheumatology clinics and were randomized to a control or intervention group. The intervention group received six weekly mailings of OA health education modules, a relaxation audio-tape and six weekly 45 min follow-up telephone self-management sessions. There was a 100% compliance rate in the intervention group, and all subjects completed baseline and three-month interviews; one subject in each group was lost to six-month follow-up. There were no significant differences in self-management between the control and intervention groups. However, at three months there were improvements in the intervention group (relative to baseline) on some outcome measures. The results suggest that the telephone may be a useful tool for reinforcing health-promoting activities for patients.

Barriers to Self-management of Serious Mental Illness and Diabetes.

OBJECTIVES Individuals with serious mental illness (SMI) (major depressive disorder, bipolar disorder, schizophrenia), and diabetes (DM), face significant challenges in managing their physical and mental health. The objective of this study was to assess perceived barriers to self-management among patients with both SMI and DM in order to inform healthcare delivery practices. METHODS We conducted 20 in-depth interviews with persons who had diagnoses of both SMI and DM. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. RESULTS Transcript-based analysis generated 3 major domains of barriers to disease self-management among patients with both DM and SMI: (1) personal level barriers (stress, isolation, stigma); (2) family and community level barriers (lack of support from family and friends); and (3) provider and health care system level barriers (poor relationships and communication with providers, fragmentation of care). CONCLUSIONS Care approaches that provide social support, help in managing stress, optimize communication with providers, and reduce compartmentalization of medical and psychiatric care are needed to help these vulnerable individuals avoid health complications and premature mortality.