Janice M. Dyehouse

The Relationship Between Executive Function, AD/HD, Overeating, and Obesity

Attention-deficit/hyperactivity disorder (AD/HD) and obesity are complex, costly disorders affecting physical, emotional, and social well-being. Executive function (EF), the cognitive ability for self-understanding and regulation, is often impaired in AD/HD, yet rarely considered in treatment of obese individuals with AD/HD. The hypothesis for this study is that low EF is seen in individuals with 4 or more symptoms of adult AD/HD and is associated with overeating behaviors leading to obesity. A nonexperimental single group design was used. A volunteer convenience sample (n = 125) completed EF, AD/HD, eating, and BMI measures. Path analysis tested the hypothesized/ modified model. Chi square (χ2 = 6.15, df = 6, p = .4) and RMSEA (0.014) indicated a very good fit for the data. Assessment of EF and AD/HD symptoms in obese individuals is supported. Further study is needed to more fully understand this relationship and to develop strategies to address overeating behaviors in obese individuals with AD/HD.

Current Screening Instruments Related to Alcohol Consumption in Pregnancy and a Proposed Alternative Method

Because alcohol is a known teratogenic substance that negatively affects the fetus, screening for alcohol use is included in maternal child texts for nurses. They present no standard screening approach, however. In the general literature, a multitude of screening instruments exist for the purpose of detecting maternal alcohol dependence but few allow the nurse to detect fetal alcohol exposure in the absence of maternal alcohol dependence. After a comparative analysis of existing screening instruments, we concluded that the Timeline Followback method has the most utility as a screening instrument to detect fetal exposure to alcohol. The purpose of this article is to present a critical review of current screening instruments related to alcohol consumption in pregnant women and to propose the use of the Timeline Followback method as the preferred approach.

Effects of a Motivational Interviewing Intervention to Decrease Prenatal Alcohol Use

This study determined the effectiveness of motivational interviewing (MI) to decrease prenatal alcohol use, while examining mechanisms of behavior change based on self-determination theory that may have evoked decreases in drinking behaviors. In all, 67 pregnant women who reported previous-year alcohol use were randomly assigned to an MI intervention or comparison group, with 56 women completing all study procedures. Both groups were assessed at baseline and 4- to 6-week follow-up for alcohol use and mechanisms of behavior change (basic psychological needs satisfaction and autonomous motivation). Only the MI group received the intervention after baseline assessments. Although MI was not found effective in decreasing prenatal drinking behaviors in this study, nonspecific factors were identified, such as treatment structures, participant motivation for improvement, and provider qualities, which may have influenced these results. More research is needed to determine theory-based specific and nonspecific factors that drive effective nursing interventions to decrease alcohol use during pregnancy.

Sensitive topics and adolescents: making research about risk behaviors happen.

This article discusses conducting research with adolescents as a positive experience, both from a clinical and scholarly perspective. However, topics involving risk-taking behaviors may be especially difficult for adolescents to discuss openly. To implement research protocols with the adolescent population, particularly when dealing with risk-taking behaviors, investigators need to be aware of developmental challenges that warrant specific methodological choices. In a pilot study that involved adolescents who had been hospitalized for traumatic injury, the researchers gained valuable experience in conducting a study on substance use. Experiences with the study provide direction for future research about investigating sensitive topics with adolescents.

Alcohol and health content in nursing baccalaureate degree curricula.

AbstractGlobally, a paradigm shift has occurred in the field of alcohol and health from treatment of alcoholism to reducing at-risk drinking. The purpose of this study was to determine if schools of nursing include content reflective of the new paradigm in their Bachelor of Science in Nursing curricula. This was a cross-sectional electronic survey of schools of nursing to determine the mean number of alcohol-related content hours presented, the content offered, and the inclusion of strategies aimed at reduction of at-risk drinking such as screening and brief intervention. The schools (n = 66) reported a mean of 11.3 hours of alcohol-related content, with most of the content related to the treatment of alcohol dependence. Less than 10% required competency in screening and brief intervention. This gap in Bachelor of Science in Nursing curricula carries serious implications in that nurses may not have the knowledge and competencies needed to provide interventions to patients with at-risk alcohol use.

Laboratory measures of alcohol (ethanol) consumption: strategies to assess drinking patterns with biochemical measures.

Alcohol (ethanol) use is a global, health-related problem that spans a continuum ranging from low-risk, at-risk, and problem drinking to alcohol dependence and chronic abuse. Clinicians and researchers alike have the need to quantify drinking patterns to determine the risk for adverse, health-related events such as injury, liver damage, and cancer. Biochemical measures of ethanol consumption are affected by temporal patterns of drinking as well as individual characteristics such as gender and age. The choice of a laboratory analysis to determine ethanol consumption is complex; no single laboratory test will predict drinking accurately across all drinking patterns, across the life span, and across gender. In conjunction with interviews and physical assessment, however, biochemical laboratory tests are sensitive tools used to measure both recent and long-term patterns of alcohol consumption.

Patterns of drinking four weeks prior to an alcohol-related vehicular crash

Objective:The primary objective of the study was to determine if drinking patterns on the days immediately prior to an alcohol-related motor vehicle crash (ARMVC) were significantly different than drinking patterns in the weeks prior to the crash. Methods:Following ARMVC, 187 hospitalized non-alcohol dependent young-adults (43 females, 144 males) were enrolled. Mean age was 29.03 years, mean blood alcohol level was 165.18 mg/dL, and mean injury severity score was 10.50. When alcohol-free, subjects were interviewed by nurse clinicians to determine the quantity/frequency of alcohol consumption during the 28 days prior to the crash. Subjects reported the number of standard drinks using the Timeline Followback procedure. Total drinks/day were determined, with day 1 considered 4 weeks prior to the crash and day 28 the day of the crash. A random-intercepts general linear mixed model (GLMM) was used to test the effect of several covariates (segment 1 [days 1–26], segment 2 [days 27–28], age, sex, race, holiday/non-holiday period, driver/passenger status, and weekend/weekday crash) on the amount of standard drinks/day. Results:There was no significant interaction among the covariates. The only significant predictors of drinks/day were segment 2 (b = .322, p < .0001) and gender (b = −.221, p = .016). The positive, statistically significant slope for segment 2 indicated an increase in consumption of drinks/day in the two-day period prior to the ARMVC and the negative slope for gender indicated greater consumption of drinks/day for men than women. Conclusion: Persons injured in an ARMVC had a significant increase in alcohol consumption on the day before and the day of vehicular crashes (days 27 and 28) as compared to the first 26 days in the 28-day period preceding the crash. When non-alcohol-dependent subjects are counseled to reduce their risk of traffic crashes, they should be alerted that when their patterns of drinking change, they are at higher risk than usual for a crash.

Assessing acute and critically ill patients for problem drinking.

More critically ill patients have acute drinking problems than chronic problems with alcohol dependence. A hospitalization offers an opportunity for nurses to perform a brief assessment and initiate a simple intervention to advise patients to reduce their drinking. A few minutes of advice may make a long-term difference in a patients health.

The Relationship Between Executive Function, AD/HD, and Obesity

Attention-deficit/hyperactivity disorder (AD/HD) and obesity (body mass index > 30) are complex and costly disorders with profound effects on the physical, emotional, and social well being of individuals, their families, and society. Both are associated with multiple comorbid physical and psychological conditions and healthcare costs amounting to billions of dollars. Prevalence studies have shown a disproportionate incidence of AD/HD in obese individuals. Obese individuals with AD/HD often require greater treatment time, incur greater treatment costs, and are frequently less successful in treating their obesity than are their counterparts without AD/HD, leaving them at higher risk for the physical and emotional complications of obesity. Impaired executive functioning (EF), the cognitive ability for self-understanding and regulation, is a fundamental characteristic of AD/HD. However, EF and AD/HD are rarely considered in the clinical assessment or treatment of the obese individual. Little is known about executive function, symptoms of adult AD/HD, and their relationships with overeating behaviors that contribute to obesity. The purpose of this study was to test the hypothesis that there is a significant predictive relationship between EF, AD/HD, overeating, and obesity. The hypothesis was that low EF in the domains of attention and impulsivity is seen in individuals with four or more symptoms of adult AD/HD and is associated with specific overeating behaviors of increased emotional eating, low cognitive restraint to food, high disinhibition around food, and high susceptibility to hunger, which contribute to adult obesity. This study used a nonexperimental single group design to test the hypothesis proposed above. Data collected from 125 volunteer community participants included the Stroop Test and Barratt Impulsivity Scale as measures of executive function; the Adult Self Rating Scale–IV, a selfreport screen of adult AD/HD symptoms; the Emotional Eating Scale and Eating Inventory subscales of disinhibition, cognitive restraint, and hunger as self-report measures of overeating behaviors; and body mass index, a measure Western Journal of Nursing Research Volume 30 Number 8 December 2008 1026-1027