Karen G. Schepp

CAUSAL ANALYSIS OF EXERCISE AND CALCIUM INTAKE BEHAVIORS FOR OSTEOPOROSIS PREVENTION AMONG YOUNG WOMEN IN THAILAND

The goal of health education is to provide information to affect attitudes, beliefs, and intentions for behavior change. However, little is known about the effects of changes in knowledge on behaviors for osteoporosis prevention. Our objective is to develop and test theoretical models of the effects of knowledge, attitude, and self-efficacy on exercise and calcium intake among young women before and after an intervention program. First, we hypothesized that knowledge would positively predict attitude, self-efficacy, calcium intake, and exercise. Second, attitude would positively predict self-efficacy, calcium intake, and exercise. Third, self-efficacy would positively predict calcium intake and exercise. Fourth, attitude and self-efficacy would mediate the effect of knowledge on calcium intake and exercise. At the beginning and end of the study, participants in the control group and intervention group completed the osteoporosis knowledge test, the osteoporosis health belief scale, the osteoporosis self-efficacy scale, a self-report for food records, and exercise. The causal model was examined as a result of our study. After the intervention program, calcium intake and exercise were predicted by knowledge when mediated by attitudes and self-efficacy. The final model accounted for 30% and 45% of the variance in calcium intake and exercise, respectively. We conclude that interventions to enhance young womens knowledge and self-efficacy may result in increased calcium intake and exercise.

Physician, patient, and contextual factors affecting treatment decisions in older adults with cancer and models of decision making: a literature review.

PURPOSE/OBJECTIVES To review physician, patient, and contextual factors that affect treatment decision making in older adults diagnosed with cancer, and to relate those factors to theoretical models of decision making. DATA SOURCES PubMed (1966 to April 2010), PsycINFO (1967 to April 2010) and CINAHL® (1982 to April 2010) databases were searched to access relevant medical, psychological, and nursing literature. DATA SYNTHESIS Physician factors in treatment decisions included physicians personal beliefs and values, medical expertise, practice type, perception of lowered life expectancy, medical factors, power, and communication style. Patient factors included personal beliefs and values, ethnicity, decisional control preferences, previous health-related experience, perception of the decision-making process, and personal factors. Contextual factors included availability of caregiver, insurance, financial status, and geographical barrier. CONCLUSIONS A diverse group of factors were identified, which are likely to form a unique framework to understand clinical decision making and plan future investigations in older adult patient populations. Using longitudinal and prospective designs to examine the real-time interplay of patient, physician, and contextual factors will enable a better understanding of how those divergent factors influence actual treatment decisions. IMPLICATIONS FOR NURSING Oncology nurses can advocate autonomous (patient-driven), shared, or family-controlled treatment decisions, depending on an older patients decisional role preference. Nurses can support patient autonomy during treatment decision making by coaching patients to engage in discussion of various evidence-based treatment options and a comprehensive discussion of the probability of success for each option with specialist providers. Oncology nurses may be able to promote treatment decisions that are consistent with a patients personal preferences and values, with strong consideration of the patients personal contexts.

Validation and testing of the Acceptability E-scale for web-based patient-reported outcomes in cancer care

The performance of the Acceptability E-scale was tested in a sample of 627 adult and older adult patients from various oncology clinics who completed an electronic symptoms survey. The revised Acceptability E-scale has strong psychometric properties and can be useful in assessing the acceptability and usability of computerized health-related programs in oncology and other health population.

Adherence and nonadherence to antipsychotic medications

The aims of this study were to identify dimensions of reasons for adherence and nonadherence to antipsychotic medications, and their associations with clinical and demographic profiles. A total number of 106 participants with DSM-IV psychosis spectrum disorders from two larger studies in inpatient and community settings participated. The Rating of Medication Influences (ROMI) Scale was used to measure subjective reasons for adherence and nonadherence. A series of multiple regression analyses found that mood symptom scores on the Positive and Negative Syndrome Scale (PANSS) predicted most dimensions of reasons for adherence and nonadherence. Higher mood scores were associated with positive affinity for medications and positive relationship with clinicians. Lower mood scores predicted four out of five reasons for nonadherence. Adherence and nonadherence behaviors were determined by different variables and were not mirror opposites.

Adolescent suicide: views of adolescents, parents, and school personnel

The purpose of this study was to survey adolescents, parents, and school personnel to assess knowledge, skill, and program needs in the schools and community in order to prevent adolescent suicide. The subjects were 57 adolescents, 63 parents, and 49 school personnel from three public high schools in a southwestern United States community. A 21-item survey questionnaire was constructed to assess the perceptions of the three groups in relation to their level of knowledge, skill, and resource awareness for assisting a suicidal adolescent. Diversity in knowledge, skill, and resource awareness within the groups, as well as findings unique to each group, were noted. Implications for school-based suicide prevention education programs are discussed.

Depressive Symptoms and Functional Impairment Among Amyotrophic Lateral Sclerosis Patients in South Korea

Purpose: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease, resulting in physical and psychological distress. Little is known about the health of ALS patients in South Korea. The purpose of this study was to assess the degree of functional impairment and depressive symptoms and their interrelationships in Korean ALS patients. Method: In this cross‐sectional descriptive study, a convenience sample of 62 ALS patients was recruited. Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) and Beck Depression Inventory (BDI) were used. Results: The mean score of ALSFRS was 18.98 and 24.50 for BDI. Severity of depressive symptoms was associated with gender, employment, perceived health status, and ALS type. A greater functional impairment was associated with greater depressive symptoms. Conclusions: This study reports high prevalence of depressive symptoms in ALS patients. The findings add to the body of knowledge on emotional health and provide motives for interventions to promote mental health of these patients.

The relationship between symptoms and stress in adolescents with schizophrenia.

Stress predicts outcomes in adults with schizophrenia, but its effect in adolescents is unknown. We used exploratory data analysis to examine changes in symptoms and to correlate symptoms with stress at 0, 6, 30, and 54 weeks in 40 adolescents with schizophrenia. Symptoms were measured with the Early Signs and Symptoms Scale; stress was measured with the Hassles Scale. From baseline to 54 weeks, symptom severity decreased significantly. Symptom severity and stress correlated significantly at baseline, 30 weeks, and 54 weeks, after controlling for the number of hospitalizations and baseline symptom severity. These results implicate stress in schizophrenia symptoms in adolescents and justify examining stress management for these patients.

Trait routinization, functional and cognitive status in older adults

This study examined the associations between trait routinization and functional and cognitive as well as demographic indicators. A sample of American older adults living independently in a retirement community (n = 80) were assessed regarding their functional status, cognitive status, and preference for routine. Robust associations between functional status and trait routinization were found, as well as correlations between education, age, and routinization. No association between routinization and cognitive status was found. The results suggest that trait routinization is linked with various aspects of well-being in older age. Various explanations regarding the role of trait routinization and its validity are presented.

The stewardship model: current viability for genetic biobank practice development.

The “stewardship model” of ethics relationships is a conceptual framework initially proposed by Jeffers in Advances in Nursing Science, 24(2), 2001. It conceptualized ethical responsibilities in the practice of systematic collection and storage of biospecimens in biobanks for future healthcare genetic research. Since the articles publication 8 years ago, genetic biobanks have grown in number around the world and discernible biobank relational conceptualizations were published. Nursing leadership adopted competency standards for all genetic nursing practices. The involvement of nurses has increased and is projected for further significant increase as biobank practices emerge from research into clinical care settings. This assessment of current viability of this previously established stewardship model offers fresh insights to existing and future nursing research and practice. The purpose of this article was to analyze the original stewardship models components, the relational parties, and characteristics; by contrasting those with proposed conceptualizations and existing biobank practices developed subsequent to its publication. The models current viability and theoretical development status are assessed for its ability to support a future nursing evidence base for best practices. Proposals for the models expansion are suggested.

Experiences of Asian American Parents in a Group Intervention for Youth With Schizophrenia

PROBLEM: Schizophrenia, which frequently strikes during adolescence or young adulthood, can have devastating effects on the family. Parents, who are primary caregivers for mentally ill adolescents, often lack the information and skills necessary to cope with the multiple and complex consequences of a major psychiatric disorder. Moreover, parents are ill- prepared to help their other children cope with the unpredictable changes that accompany having a mentally ill sibling. Asian American parents face similar issues in dealing with their schizophrenic adolescents. However, there is limited information available about this population. METHODS: The purpose of this qualitative study was to examine the experiences of four Asian American parents who participated in a community-based, family-centered, self-management intervention program for youth with schizophrenia. Participants were interviewed using semistructured interviews and language interpreters. Data were analyzed utilizing content analysis. FINDINGS: Four themes were identified: (a) same, but different; (b) sharing and learning; (c) using skills learned; and (d) working with interpreters. CONCLUSIONS: Results indicate that Asian American parents valued their participation in the group intervention and emphasized their similarities with non-Asian American families who have a mentally ill youth.