Joy Nanda

The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation

Patients with breast cancer who undergo autologous bone marrow/peripheral blood stem cell transplantation (ABMT) cope not only with a life-threatening medical treatment, but also with multiple, interrelated symptoms including pain, fatigue, psychological distress, and nausea. The purpose of this study was to determine, in a randomized controlled clinical trial, whether a comprehensive coping strategy program (CCSP) was effective in significantly reducing pain, fatigue, psychological distress, and nausea in patients with breast cancer who underwent ABMT. The CCSP was composed of preparatory information, cognitive restructuring, and relaxation with guided imagery. Randomization placed 52 patients in the CCSP treatment group and 58 patients in the control group. The CCSP was found to be effective in significantly reducing nausea as well as nausea combined with fatigue 7 days after the ABMT when the side effects of treatment were most severe. These results are important given the high incidence of nausea and fatigue in the ABMT population. The CCSP-treated group experienced mild anxiety as compared with the control group who reported moderate anxiety. The greatest effectiveness of CCSP may correspond to the time of the greatest morbidity for patients with breast cancer who have undergone ABM.

A randomized comparison of A-CASI and phone interviews to assess STD/HIV-related risk behaviors in teens

PURPOSE To compare response bias associated with a telephone survey of sexually transmitted disease/human immunodeficiency virus (STD/HIV)-related risk behaviors and an in-home self-administered audio computer assisted self interview (A-CASI). METHODS We randomly assigned an urban household sample of 223 African-American adolescents to a telephone interview or an A-CASI in their home. The sample was previously recruited by telephone for an earlier study regarding STDs and sexual behavior. We queried participants about their STD/HIV-related risk behaviors. We also assessed their perceived comfort, honesty, and accuracy in answering questions in the different modes through a telephone computer-assisted self-interview (T-CASI). RESULTS There were no significant differences by mode in percentages of participants reporting STD/HIV-related risk behaviors, except more A-CASI participants reported having engaged in sexual intercourse in past 3 months (43.8% vs. 33.3%). There were no differences in perceived comfort, honesty, and accuracy in answering questions in the different modes. These results also did not change after we adjusted for age, household structure, and current school enrollment. CONCLUSIONS Telephone interviews, a more economical mode, can be employed without much risk of increasing the response bias in the data assessing crude measures of risk.

The Differential Impact of WIC Peer Counseling Programs on Breastfeeding Initiation across the State of Maryland

This cross-sectional study examines Maryland’s women, infants, and children (WIC) breastfeeding initiation rates by program participation. The authors report on data regarding demographic and health characteristics and infant feeding practices for infants (n = 18 789) newly WIC-certified from January 1, 2007 to June 30, 2007. The authors compared self-reported, breastfeeding initiation rates for 3 groups: peer counselor (PC-treatment group) and two comparison groups, lactation consultant (LC), and standard care group (SCG). Reported breastfeeding initiation at certification was 55.4%. Multiple logistic regression analysis, controlling for relevant maternal and infant characteristics, showed that the odds of breastfeeding initiation were significantly greater among PC-exposed infants (OR [95% CI] 1.27 [1.18, 1.37]) compared to the reference group of SCG infants, but not significantly different between LC infants (1.04 [0.96, 1.14]) and the SCG. LC and SCG infants had similar odds of breastfeeding initiation. In the Maryland WIC program, breastfeeding initiation rates were positively associated with peer counseling. J Hum Lact. 25(4):435-443.

Examining the Influence of Coping with Pain on Depression, Anxiety, and Fatigue Among Women with Breast Cancer

Abstract Breast cancer treatment can have a profound influence on a womans physical, psychological, social, and spiritual well-being. Anxiety, depression, anger, fatigue, and fear of recurrence are common responses to a diagnosis of breast cancer and undergoing breast cancer treatment. Women develop their own coping strategies for the pain and other effects of treatment. However, it is unclear whether there is a relationship between adaptation to pain and psychological distress during breast cancer treatment. Findings from the present study reveal that breast cancer patients who have better pain coping strategies also have lower levels of anxiety, fatigue and depression. These results suggest that pain coping interventions may reduce fatigue and psychological distress among women with breast cancer.

Early Postpartum: A Critical Period in Setting the Path for Breastfeeding Success

BACKGROUND In the United States, most mothers who initiate breastfeeding will either stop or begin supplementing with formula before their infants are 3 months old. Routine breastfeeding education and support following hospital discharge are critical to breastfeeding success. The purpose of this article is to identify this critical period for supporting and reinforcing breastfeeding. METHODS We will use data from participants enrolled in the Maryland State Program of the U.S. Department of Agricultures Supplemental Nutrition Program for Women, Infants, and Children (WIC). This cross-sectional study will explore whether breastfeeding patterns during the period between birth and postnatal WIC certification differ by participation in a local WIC agency that provides breastfeeding peer counselor support (PC) versus two comparison groups, the lactation consultant (LC) and standard care (SC) groups. RESULTS During 2007, 33,582 infants were enrolled in the Maryland State WIC program. Infant breastfeeding status was categorized as exclusively breastfeeding, partially breastfeeding, or not breastfeeding. At certification, 30.4% of infants were breastfeeding, 25.3% had been breastfed but had stopped before certification in WIC, and 44.3% never breastfed. The breastfeeding initiation rate was higher for the PC group compared with the LC and SC groups (61.6% vs. 54.4% and 47.6%, respectively; p < 0.001). Participants in the PC group were more likely to certify as exclusively and partially breastfeeding compared with the LC and SC groups (36.0% vs. 24.8% and 25.3%, respectively; p < 0.001). CONCLUSION Our analysis identifies a window of opportunity during which targeted contact with breastfeeding mothers could enhance longer-term breastfeeding rates.

Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy

This study aims to examine the effectiveness of a self‐management multimodal comprehensive coping strategy program (CCSP) on quality of life (QOL) among breast cancer patients 1 year after treatment.

Performance of Focus ELISA Tests for HSV-1 and HSV-2 Antibodies Among University Students With No History of Genital Herpes

Objectives: To define the performance characteristics of the Focus ELISA HSV-1 and HSV-2 assay among 100 university students. Study Design: HSV-1 and HSV-2 Focus ELISA and Western Blot assays were performed on sera from university students who reported no history of genital herpes. Results: HSV-2 and HSV-1 seroprevalence by Western Blot were 3.4% and 48%, respectively. In this population, the positive predictive value of the Focus HSV-2 ELISA was 37.5%, the sensitivity was 100%, and specificity was 94.1%. The PPV of the Focus HSV-1 ELISA was 96.7%, the sensitivity was 69.0%, and the specificity was 97.8%. Conclusions: In this low-prevalence population, the positive predictive value of the Focus HSV-2 ELISA test was low. This finding, together with those reported elsewhere, indicates that caution is warranted when recommending HSV screening in low-prevalence or heterogeneous populations. Consideration should be given to raising the cutoff index value for defining a positive test result.

Young motherhood and infant hospitalization during the first year of life.

We studied the relationship of young maternal age with infant hospitalization using data from the National Longitudinal Survey of Youth for 3,130 infants born between 1979 and 1983 to mothers aged 14-25 years. Data on the mothers were first collected in 1979 and yearly thereafter. Data on their children were collected starting in 1982. Logistic regressions of infant hospitalization rates were estimated for first and second and higher births. The odds of infant hospitalization during the first year of life increased with decreasing maternal age, even with adjustment for sociodemographic characteristics, preventive health-care practices, and newborn health status, factors hypothesized to explain the maternal age effect. The maternal age relationship with hospitalization differed by birth order; among second and higher births, the odds of hospitalization was increased only for infants of mothers aged 20-22 years. Male infants, infants with a first well-baby visit after the first month of life, with birth weights between 1501 and 2500 g, and with nursery stays longer than 1 week also had increased odds of hospitalization. Ethnicity, grandmothers education, poverty status, mothers school enrollment, and family composition were not related to the odds of hospitalization, nor was smoking during pregnancy when adjustment was made for birth weight and length of nursery stay.

Recruitment Strategies and Motivations for Sexually Transmitted Disease Testing among College Students.

Objective The authors evaluated procedures for recruiting college students for sexually transmitted disease (STD) testing as part of a research study examining the impact of HSV serologic testing. Participants A convenience sample of 100 students was drawn from students aged 18 to 35 years enrolled at one university in a mid- Atlantic state between September 2004 and March 2006. Methods: Six strategies were used to recruit students for participation in the study. Upon enrollment, participants were asked where they heard about the study. Students were also asked about their motivations for participation. Results: Findings show that a significant recruitment strategy involves targeting places where students seek health care. Other effective strategies include those where information is directly provided to individuals. Most students were motivated to participate because of a possible past exposure to herpes simplex virus 2. Conclusions: Targeting places where students seek health care and educating students about STDs are important strategies for recruiting students for STD testing.

Complementary and alternative medical practice: self-care preferred vs. practitioner-based care among patients with asthma.

BACKGROUND Interest in disease self-management has increased as the US population ages, as health care costs skyrocket, and as more evidence is gathered on the etiologic basis of most chronic diseases. This study uses National Health Interview Survey (NHIS) data to analyze the association between asthma episode during the past 12 months and patterns of complementary and alternative medicine (CAM) use within the same period among adults, controlling for comorbid conditions. METHODS Using questions taken from the adult sample questionnaire and the Alternative Supplement of the 2002 NHIS, responses of those ever having asthma (N=3327) were analyzed in this cross-sectional, correlational study. The chi2 test of independence was used to examine the relationships between experiencing an asthma episode in the past year, coexisting comorbidity, and the use of self-care based CAM compared to practitioner-based CAM. RESULTS Overall CAM use differed significantly by asthma status, with 49% of those with asthma episodes using CAM compared with 42% of those who did not have an episode in the past year. Self-care based therapies were more likely to be used than practitioner-based therapies by individuals with single comorbid condition compared to those with 2 or more comorbidities. CONCLUSION Although this study supports previous work indicating that disease severity--in this instance, asthma within the past year--is significantly associated with CAM use, it did not support studies showing greater CAM use in the presence of a greater number of comorbidities, suggesting that disease burden is a limiting factor when it comes to self-care based CAM use.