Lorna Finnegan

Correlates of Physical Activity in Young Adult Survivors of Childhood Cancers

PURPOSE/OBJECTIVES To examine correlates of participation in regular physical activities among young adult survivors of childhood cancers. DESIGN Descriptive, correlational. SETTING Web-based survey. SAMPLE 117 well-educated, predominately Caucasian survivors of various types of childhood cancers (-X age = 24 years). METHODS Participants completed four rating scales, a stages of change measure, and background questions. Logistic regression and graphical methods were used to examine relationships among physical activity correlates and physical activity. MAIN RESEARCH VARIABLES Physical activity stages of change, autonomous motivation, physical activity pros and cons, self-efficacy, and self-reported worries. FINDINGS More than 80% of participants reported that they were physically active. Survivors who were autonomously motivated and who perceived fewer cons to being physically active were more likely to report being active than survivors with lower autonomous motivation scores and higher physical activity cons scores. Worries about the present and future moderated the effect of physical activity cons on physical activity. The estimated probabilities of reporting being active for women and men changed as the collective contribution of autonomous motivation, physical activity cons, and worries varied from low to high values. CONCLUSIONS Engaging in physical activity willingly and without a sense of pressure (autonomous motivation), perceiving fewer cons to physical activity participation (cognitive appraisal), and worrying about the present and future (affective response) were important correlates of self-reported physical activity beyond the influence of gender. IMPLICATIONS FOR NURSING Interventions that promote autonomous motivation, decrease physical activity cons, and address present and future worries may increase physical activity in young adult cancer survivors and may have a greater impact on women than men.

Comparison of School Food Allergy Emergency Plans to the Food Allergy and Anaphylaxis Network’s Standard Plan

Eighty-four percent of children with food allergies have a reaction in school, and 25% of first food reactions occur in schools. An evaluation was conducted comparing food allergy emergency plans to the Food Allergy and Anaphylaxis Network’s (FAAN) Food Allergy Action Plan. Of the 94 respondents, 60 provided food allergy emergency plans for comparison. Although two-thirds used food allergy plans, only 15% used the current FAAN plan. Plans were missing essential components, including emergency contact information, medication administration instructions, and health history information. School nurses must adhere to current clinical guidelines to provide an accurate resource for personnel in charge of a food allergy reaction in school. Professional associations and state school health agencies must create and market a resource that provides easy, one-stop access to current best-practice guidelines and tool kits.

Predictors of Breastfeeding Exclusivity in a WIC Sample

OBJECTIVE To examine predictors of breastfeeding exclusivity in low-income women who received services from a Chicago area clinic of the Special Supplemental Nutrition Program for Women, Infants and Children Program (WIC). DESIGN A secondary data analysis of existing clinical and administrative data. SETTING An urban community health center serving low-income families. PARTICIPANTS Two hundred and thirty-five (235) low-income women who initiated breastfeeding and received WIC services. METHODS Logistic regression models were fit to existing prenatal and postpartum data to determine predictors of breastfeeding exclusivity during the immediate postpartum period. RESULTS Only 23% of the sample breastfed exclusively. Women who received first-trimester prenatal care were more likely to exclusively breastfeed than women who entered prenatal care in later trimesters (OR = 2.02, p ≤ 0.05). Women who declared intentions prenatally to exclusively breastfeed were more likely to exclusively breastfeed than women who did not intend to breastfeed (OR = 3.85, p ≤ 0.001). Overweight/obese women were less likely to exclusively breastfeed than normal/underweight women (OR = 0.50, p ≤ 0.05). CONCLUSION Findings from this study can be used to develop tailored interventions to promote breastfeeding exclusivity among low-income WIC recipients.

The McGill Pain Questionnaire as a Multidimensional Measure in People with Cancer: An Integrative Review

First published in 1975, the McGill Pain Questionnaire (MPQ) is an often-cited pain measure, but there have been no systematic reviews of the MPQ in cancer populations. Our objective was to evaluate the MPQ as a multidimensional measure of pain in people with cancer. A systematic search of research that used the MPQ in adults with cancer and published in English from 1975 to 2009 was conducted. Twenty-one articles retrieved through computerized searches and nine studies from manual searches met the criteria. Review of the 30 studies demonstrated that pain intensity (n = 29 studies) and pain quality (n = 27 studies) were measured more frequently than pain location, pattern, and behavior parameters. Measuring cancer pain using the MPQ provided insights about disease sites, magnitude of pain, and effectiveness of treatment and intervention. Additionally, the MPQ data informed speculations about pain mechanisms, emotional status, overall sensory pain experience, changes in pain over time, and alleviating and aggravating behaviors/factors. Findings supported the MPQ as an effective multidimensional measure with good stability, content, construct, and criterion validity and showed sensitivity to treatment or known-group effects. The MPQ is a valid, reliable, and sensitive multidimensional measure of cancer pain. Cancer pain is a subjective complex experience consisting of multiple dimensions, and measuring cancer pain with the MPQ may help clinicians to more fully understand whether those dimensions of cancer pain influence each other. As a result, clinicians can provide better and effective cancer pain management.

Risk of breastfeeding cessation among low-income women, infants, and children: A discrete time survival analysis

Background:Women who receive services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) often stop breastfeeding earlier than recommended. Little is known about maternal background and intrapersonal variables that predict the timing of breastfeeding cessation over the 12-month postpartum period. Objectives:The aim of this study was to identify the maternal background and intrapersonal predictors associated with the timing of breastfeeding cessation in WIC participants over the course of the 12-month postpartum period. Method:Existing longitudinal survey and administrative data from low-income breastfeeding WIC recipients (n = 309) were analyzed using discrete time survival analysis. Risk of breastfeeding cessation was the outcome, and self-reported items were used to derive predictor variables that corresponded to the background and intrapersonal variables of the Interaction Model of Client Health Behavior. Results:Rates of breastfeeding were low (31% at 6 months and 6% at 12 months). In the best fitting discrete time survival analysis model, women who were older and of Mexican ethnicity, who had previous breastfeeding experience, and who had breastfeeding support from family or friends were at lowest risk for breastfeeding cessation at each monthly interval. Discussion:Breastfeeding duration rates were lower than Healthy People 2020 benchmarks of 61% at 6 months and 34% at 12 months. Clinicians and researchers can use the findings from this study to develop interventions that are targeted to periods of greatest risk of premature breastfeeding cessation to prolong breastfeeding duration in this vulnerable population.

The Well Woman Program: a community-based randomized trial to prevent sexually transmitted infections in low-income African American women.

In this sexually transmitted infection (STI) prevention study, we compared the efficacy of the Well Woman Program (WWP), a nurse practitioner-directed, culturally specific, intensive intervention, to minimal intervention (MI), brief lecture, and referral to usual care, in a community-based randomized controlled trial. African American women having past STIs and residing in high-risk communities were randomly assigned to the two groups. STI outcome was measured at baseline and three later points. A random effects logistic longitudinal regression model showed that, at baseline, approximately 75% of participants tested positive for an STI, predominantly trichomoniasis. At month 15, the estimated probability of a WWP participant having an STI was 20% less than an MI participant. Better STI outcomes were due to the intensive individualized intervention.

Toward theoretical understanding of the fertility preservation decision-making process: Examining information processing among young women with cancer

Background: Young women with cancer now face the complex decision about whether to undergo fertility preservation. Yet little is known about how these women process information involved in making this decision. Objective: The purpose of this article is to expand theoretical understanding of the decision-making process by examining aspects of information processing among young women diagnosed with cancer. Methods: Using a grounded theory approach, 27 women with cancer participated in individual, semistructured interviews. Data were coded and analyzed using constant-comparison techniques that were guided by 5 dimensions within the Contemplate phase of the decision-making process framework. Results: In the first dimension, young women acquired information primarily from clinicians and Internet sources. Experiential information, often obtained from peers, occurred in the second dimension. Preferences and values were constructed in the third dimension as women acquired factual, moral, and ethical information. Women desired tailored, personalized information that was specific to their situation in the fourth dimension; however, women struggled with communicating these needs to clinicians. In the fifth dimension, women offered detailed descriptions of clinician behaviors that enhance or impede decisional debriefing. Conclusion: Better understanding of theoretical underpinnings surrounding women’s information processes can facilitate decision support and improve clinical care.

Symptom Cluster Experience Profiles in Adult Survivors of Childhood Cancers

Although aggressive medical treatment protocols have led to 80% five-year survival rates for most childhood cancer patients, many long-term survivors experience multiple troubling symptoms. Using data from 100 adult survivors of childhood cancers (ACC-survivors), we used latent variable mixture modeling to generate unique subgroups of survivors based on their experiences with a cluster of eight symptoms: lack of energy, worry, pain, difficulty sleeping, feeling irritable, feeling nervous, difficulty concentrating, and feeling sad (as measured by the Memorial Symptom Assessment Scale). We also examined factors that were likely to predict subgroup membership (chronic health conditions [CHCs], health-promoting lifestyle, and demographic variables) and determined the extent to which satisfaction with quality of life (QoL) varied across the subgroups. The final mixture model included three subgroups of ACC-survivors: high symptoms (HS; n=21), moderate symptoms (MS; n=45), and low symptoms (LS; n=34). ACC-survivors who reported at least one CHC were six times as likely to be classified in the HS subgroup as compared with the LS subgroup. Mean health-promoting lifestyle scores were lowest in the HS subgroup and highest in the LS subgroup. Differences in QoL among the subgroups were statistically significant, thus validating that the subgroups were characterized uniquely for identifying those symptoms with highest life impact. To our knowledge, we are the first to identify distinct subgroups of ACC-survivors differentiated by symptom cluster experience profiles. The findings warrant additional research to confirm the subgroup-specific symptom cluster experience profiles in larger studies of ACC-survivors.

Profiles of Self-Rated Health in Midlife Adults With Chronic Illnesses

BackgroundSelf-rated health (SRH), an important indicator of cognitive appraisal of health, consistently predicts mortality, morbidity, and health services utilization. However, few explanations account for how these cognitive appraisals of health might differ within a population of midlife adults with chronic illnesses who may be at risk for further illnesses over time. ObjectivesThe purpose of this study was two-fold: (a) to uncover classes of chronically ill midlife adults who shared unique profiles of characteristics that predicted SRH over time and (b) to reveal the predictive factors of SRH for each class over time. MethodsUsing 5 waves of data (1992–2000) from the Health and Retirement Study, the sample included 6,335 respondents (ages 51 to 61 at baseline) who reported at least one chronic illness. Selected components of the Interaction Model of Client Health Behavior guided the inclusion of relevant predictors of SRH from the literature. Latent class regression was employed to simultaneously classify respondents and identify factors that predicted SRH for each class over time. ResultsThe final model reflected 3 distinct profiles of SRH over time: positive health, average health, and negative health. Four time-varying predictors differed significantly across the 3 classes: overweight, work limitation, depressed mood, and living with a partner. Three time-varying predictors—comorbidity, vigorous activity less than 3 times per week, and current smoking—had the same influence on all 3 classes. DiscussionThe differential effects of these predictors on SRH over time distinguish these results from prior research. In future studies, profiles of SRH that are unique to each class could be used to develop class-specific targeted interventions to improve cognitive appraisal of health, whereas generic interventions would be based on the class-independent predictors of SRH.

Effects of the 2011 Flood in Thailand on Birth Outcomes and Perceived Social Support

OBJECTIVE To determine the effects of displacement due to flooding during pregnancy on birth outcomes (infant birth weight and gestational age) and the moderating effect of perceived social support on the relationship between displacement and birth outcomes. DESIGN A descriptive, longitudinal study. SETTING A university-affiliated hospital in Pathum Thani, Thailand. PARTICIPANTS Pregnant women (N = 175) in the third trimester that had uncomplicated pregnancies and no history of mental illness. METHODS During pregnancy, the participants completed standardized measurements of depression symptoms, perceived social support, and questionnaires concerning the effect of the flood. After giving birth, infant birth weight and gestational age at birth were retrieved from delivery records. RESULTS Seventy percent (n = 123) of the participants experienced displacement during the flood. The displaced women had a mean infant birth weight of 175 grams less than that of the nondisplaced women, t(173) = -2.38, p = .02, whereas infant gestational age was not different. Displacement and other variables explained approximately 8% of the variance in infant birth weight. The interaction term between displacement and perceived social support was statistically significant and additionally explained the variance in infant birth weight, F(6, 168) = 3.24, p = .005. CONCLUSION Being displaced during pregnancy due to a natural disaster affected fetal growth rather than length of gestation. Health care providers should closely monitor maternal weight gain and fetal growth of pregnant women who experience displacement. Among the displaced women, social support was associated with higher infant birth weight; therefore, high levels of perceived social support may be protective for pregnant women who experience stressful events such as displacement from flooding.