Julia F. Houfek

Coping Style and Women's Participation in Breast and Gynecological Screening

Abstract The purpose of this project was to determine the role of coping style in womens practice of breast and gynecological screening behaviors. Women were classified into one of four coping groups based on measures of vigilance and screening distress. Data were analyzed from a subset of 85 U.S. women who participated in a larger longitudinal study designed to examine self-reported screening participation. Results indicate frequency of screening participation and importance of obtaining immediate mammography feedback differed across coping style groups. Women characterized as high in vigilance and screening distress were most at risk for nonparticipation in screening.

Depression and survival in head and neck cancer patients

OBJECTIVE Though depression often afflicts head and neck cancer (HNC) patients, few studies have examined the association between depression and survival in this particular cancer population. The objective of this study is to investigate the five-year survival of HNC patients by depression status. MATERIALS AND METHODS This study used SEER-Medicare data from 2002-2010 and identified depression diagnosis two years before and one year after cancer diagnosis. HNC patients were identified using ICD-O3 codes and depression was identified using ICD-9-CM codes from Medicare claims. RESULTS Of the 3466 patients included in the study, 642 (18.5%) were diagnosed with depression during the study period. Compared to those who received no depression diagnosis, those diagnosed with depression prior to cancer or after cancer diagnosis were more likely to die of cancer (HR=1.49; 95% CI=1.27, 1.76 and HR=1.38; 95% CI=1.16, 1.65, respectively). Similarly, when looking at death from any cause, those diagnosed with depression prior to cancer diagnosis and those who received a diagnosis of depression after cancer were more likely to die from any death compared to those without depression (HR=1.55; 95% CI=1.36, 1.76 and HR=1.40; 95% CI=1.21, 1.62, respectively). CONCLUSIONS The results emphasize the need for early identification and treatment of depression in HNC patients, as well as the establishment of policies to routinely screen these patients throughout the cancer treatment process.

A New Approach for Identifying Patients with Undiagnosed Chronic Obstructive Pulmonary Disease

Rationale: Chronic obstructive pulmonary disease (COPD) is often unrecognized and untreated. Objectives: To develop a method for identifying undiagnosed COPD requiring treatment with currently available therapies (FEV1 <60% predicted and/or exacerbation risk). Methods: We conducted a multisite, cross‐sectional, case‐control study in U.S. pulmonary and primary care clinics that recruited subjects from primary care settings. Cases were patients with COPD and at least one exacerbation in the past year or FEV1 less than 60% of predicted without exacerbation in the past year. Control subjects were persons with no COPD or with mild COPD (FEV1 ≥60% predicted, no exacerbation in the past year). In random forests analyses, we identified the smallest set of questions plus peak expiratory flow (PEF) with optimal sensitivity (SN) and specificity (SP). Measurements and Main Results: PEF and spirometry were recorded in 186 cases and 160 control subjects. The mean (SD) age of the sample population was 62.7 (10.1) years; 55% were female; 86% were white; and 16% had never smoked. The mean FEV1 percent predicted for cases was 42.5% (14.2%); for control subjects, it was 82.5% (15.7%). A five‐item questionnaire, CAPTURE (COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk), was used to assess exposure, breathing problems, tiring easily, and acute respiratory illnesses. CAPTURE exhibited an SN of 95.7% and an SP of 44.4% for differentiating cases from all control subjects, and an SN of 95.7% and an SP of 67.8% for differentiating cases from no‐COPD control subjects. The PEF (males, <350 L/min; females, <250 L/min) SN and SP were 88.0% and 77.5%, respectively, for differentiating cases from all control subjects, and they were 88.0% and 90.8%, respectively, for distinguishing cases from no‐COPD control subjects. The CAPTURE plus PEF exhibited improved SN and SP for all cases versus all control subjects (89.7% and 78.1%, respectively) and for all cases versus no‐COPD control subjects (89.7% and 93.1%, respectively). Conclusions: CAPTURE with PEF can identify patients with COPD who would benefit from currently available therapy and require further diagnostic evaluation. Clinical trial registered with clinicaltrials.gov (NCT01880177).

Population-based retrospective study to investigate preexisting and new depression diagnosis among head and neck cancer patients

This study aimed to estimate the pre-cancer prevalence and post-cancer incidence of depression in older adult head and neck cancer patients. Using SEER-Medicare files, cancer was identified from SEER data and depression diagnosis was identified using Medicare claims. Of 3533 head and neck cancer patients, 10.6% were diagnosed with depression during the two years prior to cancer diagnosis, and an additional 8.9% developed depression in the year following cancer diagnosis. This study supports the critical need of screening for depression throughout cancer diagnosis and treatment, as well as a preventative approach in depression development in the older head and neck cancer patient population.

Adults' perceptions of genetic counseling and genetic testing

PURPOSE This study described the perceptions of genetic counseling and testing of adults (N = 116) attending a genetic education program. Understanding perceptions of genetic counseling, including the importance of counseling topics, will contribute to patient-focused care as clinical genetic applications for common, complex disorders evolve. METHODS Participants completed a survey addressing: the importance of genetic counseling topics, benefits and negative effects of genetic testing, and sharing test results. RESULTS Topics addressing practical information about genetic conditions were rated most important; topics involving conceptual genetic/genomic principles were rated least important. The most frequently identified benefit and negative effect of testing were prevention/early detection/treatment and psychological distress. Participants perceived that they were more likely to share test results with first-degree than other relatives. CONCLUSIONS Findings suggest providing patients with practical information about genetic testing and genetic contributions to disease, while also determining whether their self-care abilities would be enhanced by teaching genetic/genomic principles.

A Pilot Study of the Psychological Impact of the Great East Japan Earthquake and Tsunami

BACKGROUND: There is evidence that a large-scale disaster may have indirect psychological impact on the individuals who were not involved with the disaster first hand. The 2011 earthquake and tsunami disasters in Japan provide an opportunity to investigate the potential global effect of indirect exposure associated with intense media coverage. OBJECTIVES: To compare the disaster’s psychological impact between Japanese and non-Japanese students; to determine what factors are associated with higher psychological impact. DESIGN: A cross-sectional, anonymous online survey of university students in the Midwest. RESULTS: Japanese students scored significantly higher on the Impact of Event Scale–Revised (IES-R) hyperarousal subscale compared with non-Japanese students. Those who were in Japan when the disaster occurred exhibited significantly higher psychological impact levels. There were significant correlations between media exposure and two IES-R subscales: avoidance and hyperarousal. CONCLUSIONS: The results support the finding from 9/11 studies that indirect exposure is associated with stress-related psychological responses.

A Concept Analysis of Resilience Integrating Genetics

ABSTRACT Although clinicians and researchers are interested in the phenomenon of resilience, there is no agreed-upon definition of resilience. Scientific evidence suggests that resilience is influenced by intrapersonal (e.g. personality traits) and environmental (e.g. social support) variables. A concept analysis was conducted to better understand the meaning of resilience. In this analysis, the antecedent of resilience was a potentially traumatic event; the defining attributes were ego-resiliency, emotion regulation, social support, and heredity; and the consequences were none to mild psychopathological symptoms and positive adaptation. This analysis can help nurses better understand resilience and its relationships to both intrapersonal and environmental variables.

Eating Self‐Regulation in Overweight and Obese Adults: A Concept Analysis

BACKGROUND Poor eating behaviors greatly influence the development of becoming overweight or obese. Learning to better self-regulate eating is one area in which individuals can positively influence their own health. PURPOSE The purpose of this concept analysis is to provide an in-depth analysis of the concept eating self-regulation as it pertains to overweight and obese adults using Walker and Avants method. RESULTS The definition for eating self-regulation formulated as a result of this concept analysis and based on the critical attributes is the ability to initiate goal-related behaviors, to consistently self-monitor dietary intake, to regularly apply willpower to resist temptations, to self-evaluate where one stands in relationship to goal attainment, and finally to maintain motivation to positively change eating behaviors. Cognitive restraint, moderation, mindfulness, disinhibition, delayed gratification, emotions and moods, self-efficacy, social support, the environment, and physical activity are the antecedents that may influence eating self-regulation. CONCLUSION Examining an individuals weight, body mass index, lipid levels, or blood pressure are some ways to determine if self-regulation of eating behavior is achieved. With a consistent definition of self-regulation and a better understanding of the critical factors that influence eating behaviors, research can better explore how to help individuals change their eating behaviors more effectively.

Adverse Events in Childhood as a Risk Factor for Elevated BMI among People with Schizophrenia and Bipolar Disorder

Diseases of obesity have become a major cause of morbidity and mortality among people with schizophrenia and bipolar disorder. Childhood adversity has been associated with adult obesity in the general public, but has not been examined among people with mental illness. This study used a secondary analysis to examine childhood adversity and body mass index in people with schizophrenia and bipolar disorder. Among females, a history of physical abuse from parents or paternal emotional neglect was associated with an increased risk for obesity (OR = 3.34 and 2.44, respectively).

Educating integrated family/ psychiatric–mental health nurse practitioners: Program development and evaluation

BACKGROUND This article describes the development, implementation, and outcomes of an integrated family nurse practitioner/psychiatric-mental health nurse practitioner (FNP/PMH-NP) program. The program was designed to help alleviate health professional shortages in rural areas. METHOD Faculty from both specialties developed a 3-year integrated curriculum, with attention to course sequencing and removing redundancies. Students completed all FNP and PMH-NP specialty courses and 855 clinical hours. Specialty integration occurred during the final semester through faculty-facilitated integrated case studies and clinical preceptorships with dual-certified rural nurse practitioners. RESULTS Thirteen students completed the program between 2006 and 2014. A survey of graduates (75% response rate) demonstrated that most were dual certified, and less than half practiced in rural areas. All were very satisfied with their nurse practitioner role. CONCLUSION The program successfully prepared graduates to care for patients across the mind-body spectrum in integrated mental health-primary care positions. More work may be needed to market the integrated role and rural practice.