Gregory Graham

Comparison of Short Scales to Measure Depressive Symptoms in Elders With Diabetes

Depression is the most common mental health problem among American elders and it is also prevalent among those with diabetes. The 20-item Center for Epidemiological Studies Depression Scale (CES-D) is commonly used to measure depressive symptoms in elders, but its length is potentially burdensome. Twelve short forms of the CES-D (4 to 16 items) exist, but they have not been tested with elders with diabetes. This study compared reliability and validity estimates across the 12 short forms and investigated similarities in classifying elders with diabetes as clinically depressed using standardized cut scores. Becks theory provides a framework for identifying the affective, cognitive, behavioral, and somatic symptoms that are measured by the CES-D. Data were merged from two studies, which yielded 80 elders with diabetes who completed the CES-D items during structured interviews. Cronbachs alpha was .87 for the CES-D; it ranged from .60 (5 items) to .84 (16 items) for shorter forms. Correlations of the full CES-D and short forms ranged from .82 (4 items) to .98 (16 items). Using the CES-D cut score, 14% of the elders with diabetes had clinically significant depressive symptoms: 21% men, 11% women, 17% African Americans, and 13% Caucasians. A 5-item scale overestimated 29% as clinically depressed: 33% men, 27% women, 25% African Americans, and 29% Caucasians. The findings suggest that shortened scales to measure depressive symptoms may be potentially useful with elders with diabetes. Further psychometric studies of the CES-D short forms are recommended with elders with chronic conditions.

Relationship between 24-H blood pressure and sleep disordered breathing in a normotensive community sample

Sleep disordered breathing (SDB) and hypertension are commonly associated. In this study, we assessed how longitudinal measures of SDB predict a 24-h ambulatory blood pressure monitoring (ABPM) profile. Participants (n = 82) were recruited from a community-based urban (26% African American) sample and included family members of patients with laboratory diagnosed SDB (cases) and family members of neighborhood control subjects evaluated at baseline and at 5 years. Nearly all participants were normotensive and were not receiving therapy for SDB. During both examinations, the respiratory distress index (RDI) was assessed with overnight in-home polysomnography. Seated blood pressure (BP) was assessed at a baseline examination (t,) and after a 5-year follow-up period (t5), when 24-h ABPM also was performed. The change in RDI (t5-t1) over 5 years was significantly associated with 24-h mean systolic blood pressure (SBP) (P = .04), 24-h maximum diastolic blood pressure (DBP) (P = .03), sleep mean SBP (P = .05), sleep mean DBP (P < .05), and sleep maximum SBP (P = .02). Regression analysis revealed that average 24-h mean arterial pressure (MAP) and mean 24-h DBP were each best predicted by change in RDI, explaining 5% of the variance in these 24-h BP readings, and by current smoking status. After accounting for these variables, BP was not predicted by any of the other potential confounders (all P > .10). Mean RDI (averaged between t5 and t1) was associated with mean MAP, mean SBP, and maximal SBP measured during sleep. This study documents for the first time the association between changes in sleep apnea activity and BP and in a community-based normotensive sample. Further long-term evaluation of the effects of these findings and the long-term consequences of hypertension are needed.

Reliability and validity of the Preterm Infant Feeding Survey: instrument development and testing.

No instruments have been located that examine attitudes concerning feeding decisions of mothers of preterm infants. The purpose of this study was to describe the development and psychometric testing of the Preterm Infant Feeding Survey (PIFS). The PIFS was adapted from the Breastfeeding Attrition Prediction Scale. The five-subscale, 78-item PIFS was tested with 105 mothers of preterm infants shortly after hospital admission. Individual subscale Cronbach’s alpha values ranged from .75 to .82. Factor analysis demonstrated a five-factor solution. The PIFS is the first instrument to examine factors that contribute to feeding decisions of mothers of high-risk preterm infants; this knowledge will support the planning of interventions to improve breastfeeding outcomes for this population. Further psychometric testing with larger samples is recommended.

Interpersonal Violence: Secondary Analysis of the Keep Your Children/Yourself Safe and Secure (KySS) Data

INTRODUCTION The purpose of the secondary analysis was to determine agreement of parents and children to the interpersonal violence (IPV) items on the Keep Your Children/Yourself Safe and Secure (KySS) survey to assess mental health concerns. METHODS A comparative, descriptive design was used to determine the level of agreement between parent/child dyads on the 15 attitude/knowledge and worry items related to IPV (n = 563 dyads). RESULTS Single mother/son and 10- to 12-year-olds had less agreement than other dyad combinations and child age groups. Six of the 10 knowledge/attitude items had significant differences, including multigenerational occurrence of sexual abuse, the effect of harsh parenting, witnessing domestic violence, and incidence of physical abuse. The least agreement was on sexual abuse, incidence of physical abuse, and outcome of strict parenting (p < .001). Parents had greater worry about the parent-child relationship than did the children (p < .001). DISCUSSION Parents and clinicians may not realize how different their understanding of IPV is from that of children. Identifying items of least agreement can inform parents and clinicians in targeting violence education and prevention.

A Password-protected Web Site for Mothers Expressing Milk for Their Preterm Infants

Background: Research has demonstrated that breast milk significantly decreases morbidities that impact length of stay for preterm infants, but there is a need to test interventions to improve breastfeeding outcomes. Since many Americans are using technologies such as the Intranet and smartphones to find health information and manage health, a Web site was developed for mothers who provide breast milk for their preterm hospitalized infants. Purpose: This study examined the efficacy of a Web site for mothers to educate them about breast milk expression and assist them in monitoring their breast milk supply. Methods: Quantitative and qualitative data were collected from mothers whose preterm infants were hospitalized in a level IV neonatal intensive care unit (NICU) or transitional care unit (TCU) in an urban academic medical center in the Midwest. Results: Eighteen mothers participated in evaluation of the Web site. Thirteen mothers consistently logged on to the password-protected Web site (mean [standard deviation] = 13.3 [11.7]) times. Most participants, (69.2%), reported they used the breast milk educational information. Most mothers indicated that using the Web site log helped in tracking their pumping. These findings can be used to direct the design and development of web-based resources for mothers of preterm infants Implications for Practice: NICU and TCU staffs need to examine and establish approaches to actively involve mothers in monitoring the establishment and maintenance of an adequate supply of breast milk to improve neonatal health outcomes. Implications for Research: An electronic health application that incorporates the features identified in this study should be developed and tested.