James D. Leeper

Physiologic and behavioral effects of gentle human touch on preterm infants.

The purpose of this study was to evaluate the effects of a gentle human touch (GHT) intervention provided to 42 preterm infants (27-33 weeks gestational age), for 10 min, three times daily for 10 days. There was no significant difference in mean HR levels or in percent of abnormal heart rate (HR) or O2 saturation comparing 10-min baseline (B), GHT, and 10-min post-touch (PT) phases. There were significantly lower levels of active sleep, motor activity, and behavioral distress during GHT compared to B and P phases. There were no differences among the 42 infants in the GHT group and 42 infants in a randomly assigned control group on any outcome variable including weight gain, morbidity status, or behavioral organization. The findings suggest that GHT generally is a safe and soothing type of touch to provide to young preterm infants, but that individual infant responses to touch need to be continuously monitored by NICU staff and parents.

Inside the hidden mental health network: Examining mental health care delivery of primary care physicians

Mental disorder diagnoses among 51 patients, made by a group of 20 family physicians, were compared with diagnoses generated by the Diagnostic Interview Schedule (DIS). Processes of diagnosis, decision making, and treatment planning were then examined through structured physician interviews and chart audits. In this study, 75 of 94 DIS diagnoses (79%) were undetected. During interview and chart audit, the physicians were found to have consistently underestimated, misinterpreted, or neglected psychiatric aspects of care among a majority of patients in the study. These physicians had all satisfactorily completed a psychiatry curriculum designed for family physicians. Analysis of these results suggests that a mental health role is often not integrated into primary care practice, regardless of physician performance during psychiatric training experiences. Assumption of this role appears to be state dependent on involvement with a psychiatric treatment setting. Primary care practice patterns do not seem to result in application of appropriate skills and therapeutic attitudes to detect, diagnose, and correctly manage the majority of mental disorders that occur. The need is reaffirmed for active collaboration between mental health professional and primary care providers in training and in incorporation of psychiatric skills into primary care practice.

Growth curve analysis of complete and incomplete longitudinal data

Growth curve analysis is reviewed for both complete and incomplete data structures. Specific attention is paid to the incomplete data model of Kleinbaum and its applicability to the mixed longitudinal study. Design considerations and efficiency for various incomplete longitudinal studies are also discussed.

Family Caregiving to Those With Dementia in Rural Alabama Racial Similarities and Differences

This study explored differences and similarities in the experiences of African American and White family caregivers of dementia patients living in rural Alabama. This cross-sectional survey used a caregiving stress model to investigate the interrelationships between caregiving burden, mediators, and outcomes. Random-digit-dialing telephone interviews were used to obtain data on a probability sample of 74 non-Hispanic White and 67 African American caregivers. White caregivers were more likely to be married and older, used acceptance and humor as coping styles, and had fewer financial problems. African American caregivers gave more hours of care, used religion and denial as coping styles, and were less burdened. The authors have developed a methodology for obtaining a representative sample of African American and White rural caregivers. Further investigations are needed of the interactions between urban/rural location and ethnic/racial backgrounds of dementia caregivers for heuristic and applied reasons.

Knowledge and attitudes toward breast-feeding: Differences among dietitians, nurses, and physicians working with WIC clients

We assessed the knowledge of and attitude toward breast-feeding of dietitians, nurses, and physicians who work with individuals in the Alabama Special Supplemental Food Program for Women, Infants, and Children. On a scale of 0 to 100, dietitians expressed stronger interest in lactation (78.6) and exhibited greater knowledge (79.6) of the questions asked than nurses (74.5 and 73.0, respectively). Attitude and knowledge scores of physicians (70.2 and 75.5, respectively) were not statistically different from those of dietitians or nurses. Respondents disagreed greatly about the relationship of breast-feeding to weight loss and the appropriateness of oral contraceptives during breast-feeding 6 weeks postpartum. Professionals were more knowledgeable about benefits to infants than about maternal concerns. Results of this study suggest that professional breast-feeding education programs should address maternal concerns such as weight loss, contraception, and mastitis as well as benefits to the infant.

Analysis of Incomplete Data from Longitudinal and Mixed Longitudinal Studies

SUMMARY An attempt has been made in this paper to outline methods of analysis which may be applied to incomplete longitudinal data. A specific example dealing with the estimation of a mean vector has served as the vehicle of comparison of two methods of analysis: (a) a mixed longitudinal analysis due originally to Rao and Rao (1966) and (b) a cross-sectional type of analysis. The mixed longitudinal model has been framed within the context of a more general model proposed by Kleinbaum (1973). By simplifying the model in a special case to the usual univariate linear model, the methods described may be carried out on conventional linear model computer programs. Limitations of the method of analysis are discussed.

Coping Strategies and Caregiving Outcomes Among Rural Dementia Caregivers

We studied the coping styles by which family caregivers living in rural areas of Alabama deal with the demands of caring for an older relative with dementia. Data were obtained from a sample of 141 caregivers through the random-digit dialing telephone survey. Two coping styles were identified: deliberate coping and avoidance coping. Deliberate coping was related to higher life satisfaction scores and, avoidance coping was related to lower life satisfaction scores and higher caregiver burden scores. Avoidance coping appeared to moderate the effects of caregiver health on caregiver burden. Social workers should pay greater attention to caregivers with dysfunctional coping styles.

Body Image, Anthropometric Measures, and Eating-Disorder Prevalence in Auxiliary Unit Members

CONTEXT Medical professionals have recognized eating disorders and related problems in competitive athletes. Auxiliary members (color guard, dance, majorettes) experience the same appearance-related pressures observed in sports commonly associated with eating disorders. OBJECTIVE To estimate eating-disorder prevalence based on associated eating-disorder characteristics and behaviors in female auxiliary members and to compare perceived and ideal body images and anthropometric measurements between at-risk and not-at-risk participants for eating-disorder characteristics and behaviors. DESIGN Cross-sectional design. SETTING Three universities in the southeastern United States. PATIENTS OR OTHER PARTICIPANTS Participants (n = 101, mean age = 19.2 +/- 1.2 years) represented 3 auxiliary units, including color guard (n = 35), dance line (n = 47), and majorettes (n = 19). MAIN OUTCOME MEASURE(S) Participants self-reported menstrual history, height, and weight. Anthropometric measurements included height, weight, body fat percentage, and waist and hip circumferences. We screened for eating-disorder risk behavior with the Eating Attitudes Test (EAT)-26 and for body dissatisfaction with the Figural Stimuli Survey. RESULTS Based on the EAT-26, we estimated eating-disorder prevalence among members to measure 29.7% (95% confidence interval = 20.8%, 38.6%). The EAT-26 results revealed that 21% of participants used purgatives and 14% vomited to control weight or shape. The at-risk group had higher scores on the EAT-26 total (P <or= .01) and on the dieting (P <or= .01), oral control (P = .02), and bulimia (P = .01) subscales. Hip circumference (P = .01), self-reported weight (P = .03), measured weight (P = .04), difference between measured and preferred weights (P = .02), and calculated target weight (P = .02) were different between the at-risk and not-at-risk groups. CONCLUSIONS Collegiate auxiliary unit members may have an unacceptable prevalence of eating disorders. Our results validate concerns that auxiliary members may exhibit an unacceptable eating-disorder risk, highlighting the need to examine and address unhealthy weight-management behaviors independent of eating-disorder status.

Drinking Likelihood, Alcohol Problems, and Peer Influence Among First-Year College Students

Excessive alcohol consumption is a predominant health concern on college campuses in the United States. A stepwise multiple regression analysis was used to examine the predictive values of demographic factors in relation to alcohol subscales (Drinking Context Scale, College Alcohol Problems Scale-revised, and Social Modeling Scale) with the outcome of number of drinking days in the past 30 days among a sample (n = 224) of first-year college students. The final model predicted 37.5% of the variability in drinking days in the past month. All variables, except for race, were significantly associated with the outcome (p <. 05).

Racial Differences in Perceived Burden of Rural Dementia Caregivers: The Mediating Effect of Religiosity

This study explores whether religiosity explains racial differences in caregiving burden for a rural sample of dementia family caregivers. Data are from a probability sample of 74 non-Hispanic White and 67 African American dementia caregivers in rural Alabama. SPSS macros for estimating indirect effects in multiple mediator models are used to test the mediation effects of religiosity. White caregivers report higher burden, are less likely to use religious coping, and less likely to engage in organized religion than do African American caregivers. Church attendance is found to significantly (B = —.57, p < .05) mediate the racial differences on caregiving burden (R 2 = .07). Religious involvement in general, and church attendance in particular, seem to provide both spiritual and social psychological benefits to dementia caregivers. Thus, supplementing formal services with the services provided by religious organizations may be important in rural areas where formal resources are scarce.