Karyn Holm

AEROBIC EXERCISE, MATERNAL SELF-ESTEEM, AND PHYSICAL DISCOMFORTS DURING PREGNANCY

This preexperimental study explored the relationships among maternal aerobic exercise, self-esteem, and physical discomforts during pregnancy by comparing groups of exercising and nonexercising pregnant women. The convenience sample was comprised of 31 women who participated in aerobic exercise and 22 women who did not. All subjects, who were at least 27 weeks pregnant, completed three questionnaires: Self-History Form, Pregnancy Discomfort Checklist, and Rosenberg Self-Esteem Scale. The group of women who exercised had statistically significant higher self-esteem and lower physical discomfort scores than the group of women who did not exercise. Statistically significant lower scores were found in the exercise group for the symptoms of backache, headache, fatigue, shortness of breath, and hot flashes. There was a statistically significant inverse relationship between amount of exercise and discomforts reported in the third trimester. These findings suggest that exercise during pregnancy is associated with higher self-esteem and lower discomfort scores. However, interpretation of these findings is limited by a lack of random assignment to groups, which might have resulted in a selection bias.

THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND PERIMENOPAUSE

Our purpose in conducting this study was to examine the relationship between physical activity and symptoms associated with perimenopause. A group of 214 perimenopausal women aged 40-55 years (mean = 47 years) completed the Womens Health Assessment Scale (assesses symptoms associated with perimenopause: vasomotor, psychosomatic, menstrual, and sexual symptoms) and the physical activity questionnaire. These women were categorized into three groups based on their levels of physical activity: inactive, relatively active, and active. Analyses of covariance (ANCOVA) revealed significant differences between groups in frequency and distress of overall symptoms associated with perimenopause (F = 8.86, p = .00, F = 6.25, p = .00, respectively). Further analyses indicated that relatively active and active women had significantly fewer and less distressful psychosomatic symptoms (F = 8.05, p = .00, F = 5.80, p = .00, respectively), such as irritability, forgetfulness, and headache as well as fewer and less distressful sexual symptoms (F = 3.42, p = .03, F = 3.73, p = .03, respectively), such as vaginal dryness and decreased sexual desire than inactive women. No significant differences were found among groups on vasomotor and menstrual symptoms. In conclusion, physical activity may be an important alternative/adjunct to hormone therapy particularly for psychosomatic and sexual symptom management at perimenopause.

Perimenopause and the Quality of Life

The purposes of this study are to describe the frequency and distress of symptoms associated with perimenopause, to examine the changes in the quality of life (QOL) related to perimenopause, and to examine the relationships between symptoms associated with perimenopause and the QOL. A cross-sectional, correlational design was employed. Two hundred fourteen perimenopausal women completed the Women’s Health Assessment Scale (WHAS) and the Quality of Life Scale. It was found that vasomotor symptoms were not central to the list of symptoms associated with perimenopause. More women reported psychosomatic complaints as opposed to vasomotor complaints. Compared to the premenopausal period, women during perimenopause experienced slightly, yet significantly decreased, levels of QOL. Multiple regression analysis demonstrated that the psychosomatic symptom category was the sole predictor of the QOL during perimenopause. In summary, psychosomatic symptoms occur most frequently and are most distressful for perimenopausal women in this study. It may be important to manage psychosomatic symptoms to improve the QOL for perimenopausal women.

VALIDATION OF A SINGLE-ITEM MEASURE OF USUAL PHYSICAL ACTIVITY

The purpose of this study was to assess the reliability and validity of a single-item measure of Usual Physical Activity and to assess its usefulness as a physical activity tool for perimenopausal women. 188 perimenopausal women participated (age: M = 47 yr., SD = 3; range = 40–55). Data were collected using the Womens Health Assessment Scale, the Physical Activity Questionnaire, the Perimenopause-related Quality of Life Scale, a health history and demographic questionnaire, and the rater. Scores were stable over a 2-wk. interval. Convergent validity was supported by a correlation of .66 between ratings on Usual Physical Activity and the Physical Activity Questionnaire. Concurrent validity was supported by the association of the rating of Usual Physical Activity with three parameters of Body Mass Index, psychosomatic symptoms, and perimenopause-related quality of life, known to be associated with physical activity. Highly active women had a lower Body Mass Index than less active and inactive women. Active women tended to report fewer and less distressing psychosomatic symptoms and better quality of life. These findings support the use of rating of Usual Physical Activity to classify perimenopausal women into categories of physical activity.

A quantitative survey to measure energy expenditure in midlife women.

The Taylor Leisure Time Physical Activity Questionnaire and the Tecumseh Occupational Physical Activity Questionnaire were modified to measure energy expenditure in midlife women. A three-dimensional measure of female physical activity resulted which reflected leisure, occupational, and household activities. Total daily energy expenditure for the specific activities was calculated using established metabolic units and reported time spent performing the activities. Test-retest reliability was evaluated at two weeks for 15 % (n = 59) of the sample of 375 midlife women. There was high agreement on participation in the various activities, but low agreement on the time spent doing the activities. Cardiorespiratory fitness, established with a Monarch bicycle ergometer, was used to test the validity of the energy expenditure measure. Correlations were significant between cardiorespiratory fitness and both leisure activity and household activity, but not between cardiorespiratory fitness and occupational activity.

LIFELONG PHYSICAL ACTIVITY IN MIDLIFE AND OLDER WOMEN

The need for measures of physical activity in women led to this descriptive study of 375 women aged 33–62 (mean age 47±7 years). A questionnaire was developed to assess levels of lifelong physical activity (LLPAQ) with three subscales: occupation, leisure, and household. Reliability as determined by Cronbachs alpha ranged from .83–.87, while test–retest correlations ranged from .46–.57 for the subscales and total score. Correlations of the LLPAQ with cardiorespiratory fitness were positive, with a shift from highest correlation between fitness and leisure physical activity (r = .26–.29, p < .05) in younger women, to highest correlation between fitness and occupation physical activity (r = .29–.38, p < .05) in women over 50. Patterns of physical activity over the lifespan were different for each subscale; total scores showed a peak in overall physical activity between ages 25–39, and a steep decline after age 39, due to small decreases on each subscale. Relevance of a measure including household physical activity to document lifelong levels of physical activity for health studies of women is discussed.

A comparison of intravascular pressure monitoring system contamination and patient bacteremia with use of 48- and 72-hour system change intervals

OBJECTIVE To determine the incidence of culture positivity in intravascular monitoring systems by comparing 48- versus 72-hour intervals for flush solution, stopcocks, and catheters on removal. DESIGN Prospective, quasi-experimental, random assignment. SETTING Intensive care units of a midwestern university medical center and a community hospital. PATIENTS Seventy-six critically ill adult patients, ranging in age from 24 to 96 years (X = 61.6), requiring arterial or pulmonary artery catheters. OUTCOME MEASURE Culture positivity of flush solution, stopcocks, or catheter tips. INTERVENTION Data collection was initiated at designated change intervals of 48- or 72-hours; cultures were taken of flush solution and stopcocks; catheter tip cultures were obtained on catheter removal. RESULTS Chi-square analyses indicated that increasing the change interval to 72 hours resulted in no significant difference in culture positivity of catheter tips. However, the difference between the 48- and 72-hour groups in culture-positivity rates of stopcocks from arterial catheters was significant (1, N = 82) = 6.86, p less than 0.01. CONCLUSIONS Our results showed that increasing the change interval to 72 hours did not increase the risk of catheter-associated infection or catheter-associated bacteremia. Chi-square analysis did not show an association between culture-positive stopcocks, the incidence of culture-positive catheter tips, entries into the system, or catheter-related bacteremia and a change interval that was increased to 72 hours. Thus, increasing the change interval to 72 hours does not increase the risk of infection.

Immobility and bone loss in the aging adult

Increasing numbers of older patients will be admitted to critical care units. Although bone loss will not be the primary concern, astute critical care nurses must be aware that the bone loss associated with immobility, compounded with the bone loss that occurs with aging, can place a patient at the fracture threshold.

Infection related to intravascular pressure monitoring: Effects of flush and tubing changes

The optimal frequency for changing pressure monitoring tubing and flush solution that minimizes catheter-related infection and contains cost has not yet been established. We conducted a pilot study to examine the effects of three protocols on catheter-related infection: group I, change of flush solution and pressure monitoring tubing every 24 hours; group II, change of flush solution every 24 hours and change of pressure monitoring tubing every 48 hours; group III, change of flush solution and pressure monitoring tubing every 48 hours. Thirty critically ill patients were randomly assigned to one of the three protocols. Semiquantitative cultures of the solution from the flush bag and catheter tip were obtained. Intervening variables were documented: duration of cannulization, number of entries into the system, presence of other invasive devices, white cell count, patients temperature, presence of preexisting infection, patients age and diagnosis, use of steroids and antibiotics, and host risk factors for immunocompromise. All flush solution cultures were negative for growth. Incidence of catheter-related bacteremia was zero. The cultures of four catheter tips were positive for Staphylococcus epidermidis; none in group I, three in group II, and one in group III. The results of this pilot study suggest that there is no difference in the incidence of catheter-related infection whether the change interval for flush solution and pressure monitoring solution is 24 or 48 hours. However, further study with a larger sample is needed.

The measurement of physical activity in bone density research.

PHYSICAL ACTIVITY IS often recommended as a method to prevent or treat osteoporosis. Nevertheless, it is difficult to interpret the research findings upon which this recommendation is made because of problems measuring physical activity. Studies investigating the bone density-physical activity association were reviewed. Physical activity was measured by participation in a specific form of exercise, questionnaire and interview, mechanical devices, and physiological markers of activity. In about half of the exercise participation studies, grouping criteria were problematic for the nonexercise or control group. Many discrepancies were found in the questionnaire and interview studies. Overall, little information was reported with respect to reliability or validity of measures, thereby hampering comparisons across studies. These measurement issues can provide nurses with a new perspective for evaluating studies that report the impact of physical activity on bone mass and other health outcomes as well.