Catherine L. Gilliss

Correlates of fatigue in older adults with rheumatoid arthritis.

The purposes of this study were to describe the prevalence of fatigue, examine the association between fatigue and doctor visits, and identify correlates of fatigue in rheumatoid arthritis (RA). On average, a high degree of fatigue was reported to occur every day, to remain constant during the course of a week, and to most often affect walking and household chores. When controlling for disease severity and insurance coverage, respondents who reported more fatigue made more visits to the rheumatologist than those reporting less fatigue. A regression model with fatigue as the dependent variable revealed that the following variables explained a significant amount of variance: pain rating, functional status, sleep quality, female gender, comorbid conditions, and duration of disease.

Recruitment and retention of healthy minority women into community-based longitudinal research.

This report examines the impact of individualized, population-based recruitment and retention approaches on the development of a subject pool, enrollment, and retention at 12 months of healthy, community-based women in three ethnic groups: African Americans, non-Hispanic European Americans, and Mexicans/Central Americans. Of 722 women contacted and screened, 346 (48%) were eligible and consented to participate. Attrition at 12 months was low (10%) compared with other published reports. The largest group of potential subjects was identified through broadcast media approaches, but this method produced the highest number of ineligible women and highest rate of attrition. Printed matter produced the next largest group of potential subjects, but ineligibility was high (53%). Face-to-face interactions enrolled the highest proportion of eligible women (84%) and lowest overall attrition (7%). Direct referral yielded fairly efficient enrollments (57%) and average attrition. Multiple approaches for recruitment can produce a diverse sample of healthy, community-based women. Face-to-face recruitment results in the highest yield of participants with the lowest attribution but is presumed to require more resources.

The Family and Type 2 Diabetes: A Framework for Intervention:

Four broad groups of factors have been linked with self-management behavior in type 2 diabetes over time: (1) characteristics of patients, (2) amount and management of stress, (3) characteristics of providers and provider-patient relationships, and (4) characteristics of the social network/context in which disease management takes place. Of these four, social network/context has received the least amount of study and has been described in terms not easily applicable to intervention. In this paper, we identified the social network/context of diabetes management as residing within the family. We defined the family for clinical purposes, reviewed the literature concerning what is known about the link between properties of the family context of care and outcomes in type 2 diabetes and other chronic diseases, and identified areas of family life that are relevant to diabetes management. This information was then used to demonstrate how a family context of care can serve as a clinical framework for integrating all four groups of factors that affect disease management. Implications of this approach for practice and research are described.

Families and Chronic Illness: A Synthesis of Current Research

The purpose of this review of 73 articles reporting family research was to identify major areas of inquiry and to draw conclusions about what is known about families in which a member has a chronic illness. The review identified two distinct clusters of research in which knowledge is being generated. The first cluster included descriptive studies of family response to illness. The second cluster included explanatory studies of variables contributing to response to chronic illness. Within each of these two broad clusters, focused areas of inquiry were identified and the results of these studies were synthesized. The findings of the review are discussed in terms of their implications for developing nursing interventions and future research.

The Nature and Scope of Stressful Spousal Caregiving Relationships

The caregiving literature provides compelling evidence that caregiving burden and depressive symptoms are linked with stressful care relationships, however, relational difficulties around caregiving are seldom described in the literature. This article presents findings from content analysis of baseline interviews with 40 Alzheimer’s disease (AD) and Parkinson’s disease (PD) spousal caregivers enrolled in a home care skill-training trial who identified their care relationship as a source of care burden. Disappointment and sadness about the loss of the relationship; tension within the relationship; and care decision conflicts within the relationship were recurrent themes of relational stress in caregiving. These spousal caregivers had relationship quality scores below the mean and burden and depressive symptom scores above the means of other caregivers in the study. These findings provide support for developing dyadic interventions that help spouses manage relational losses, care-related tensions, and care decision-making conflicts.

Improving the Health of the Community: Duke's Experience with Community Engagement

Evidence is accumulating that the United States is falling behind in its potential to translate biomedical advances into practical applications for the population. Societal forces, increased awareness of health disparities, and the direction of clinical and translational research are producing a compelling case for AHCs to bridge the gaps between scientific knowledge and medical advancement and between medical advancement and health. The Duke University Health System, the city and county of Durham, North Carolina, and multiple local nonprofit and civic organizations are actively engaged in addressing this need. More than a decade ago, Duke and its community partners began collaborating on projects to meet specific, locally defined community health needs. In 2005, Duke and Durham jointly developed a set of Principles of Community Engagement reflecting the key elements of the partnership and crafted an educational infrastructure to train health professionals in the principles and practice of community engagement. And, most recently, Duke has worked to establish the Duke Translational Medicine Institute, funded in part by a National Institutes of Health Clinical Translational Science Award, to improve health through innovative behavioral, social, and medical knowledge, matched with community engagement and the information sciences.

Predictors of general activity 8 weeks after cardiac surgery

In this secondary analysis, the influence of mood states and self-efficacy beliefs on recovery of general activities 8 weeks after cardiac surgery were investigated. Study data were taken from a randomized clinical trial with 156 subjects who were either in an efficacy enhancement nursing care group (n = 75) or in a routine care group (n = 81). It was found that self-efficacy beliefs at time of hospitalization regarding ability to resume general activities after discharge, measured tension/anxiety at 4 weeks after surgery, and experimental group status explained 21% of the variation in self-reported recovery at 8 weeks.

Disease Management Status: A Typology of Latino and Euro-American Patients With Type 2 Diabetes

Abstract The number of indicators of chronic disease management is large and no practical framework is available to guide selection for use in intervention programs. In addition, it is often difficult to integrate multiple disease management indicators into a comprehensive picture of patient functioning. The authors present a heuristic framework for creating a profile of disease management and an empirically based descriptive typology of disease management behavior. From the literature, they identified 5 domains of disease management indicators: biologic, general health and functional status, emotional tone, quality of life, and behavioral. They selected 11 scales and assessed 187 patients with type 2 diabetes. Five statistically replicable patient disease management types were derived from exploratory and confirmatory cluster analyses and a descriptive narrative was created for each: balanced (33%), problematic (6%), coasters (34%), discouraged (16%), and distressed (11%). The typology describes different presentations of disease management that can be linked with patient-tailored interventions for patients with type 2 diabetes.

Psychosomatic symptoms in parents 2 years after the death of a child with cancer

Forty-five mothers and 30 fathers, representing 58 families, completed the Symptom Checklist 90-Revised, a measure of current psychological and somatic symptoms, 24 months after the death of a child with cancer. The mean scores from six symptom dimensions (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and hostility) and a global measure of the depth of symptomatology, the Global Severity Index, were contrasted with those of the nonpatient and psychiatric outpatient norms reported by Derogatis (1983). Two years after the childs death parents showed a symptom profile reflecting significantly greater distress than that reported by nonbereaved, nonpatient adults. The results highlight important distinctions between bereaved parents and psychiatric outpatients.

Conceptual Approaches to Studying Family Caregiving for Persons With Severe Mental Illness

This article critically analyzes the conceptual frameworks commonly used to study family caregivers who have a family member with a severe mental illness. Those frameworks that are commonly in use present significant limitations to the study of the family as a whole. In contrast, the Family Resiliency Model permits family level analysis. The authors present this model and argue for its use in studying families with members who have a severe mental illness.