Marjorie A. Pett

Inhibited sexual desire in women

A multifaceted study was conducted to identify differences in biopsychosocial characteristics between a clinical group of 59 married women who complained of inhibited sexual desire (ISD) and 31 married women who expressed normal sexual desire (non-ISD). Areas of examination included personality, endocrine, relationship, and sexual dimensions. Instruments of data collection included the MMPI, Dyadic Adjustment Scale, radioimmunoassay of testosterone and prolactin levels, and a questionnaire which focused on demographic, relationship, and sexual information. Statistical analyses indicated nonsignificant between-group differences on demographic characteristics, personality variables, and hormonal evaluation. Statistically significant differences were found between the two groups with regard to sexual history and several marital and sexual dimensions. The ISD group reported significantly greater dissatisfaction with these areas than the non-ISD group. Implications for clinical practice and research are discussed.

CERVICAL CANCER BELIEFS AND PAP TEST SCREENING PRACTICES AMONG CHINESE AMERICAN IMMIGRANTS

PURPOSE/OBJECTIVES To examine beliefs and Pap test utilization among Chinese American women, the largest Asian female population in the United States. RESEARCH APPROACH Cross-sectional descriptive, correlational study. SETTING Metropolitan areas of Portland, OR. PARTICIPANTS 100 foreign-born Chinese women aged 40 years and older. METHODOLOGIC APPROACH Three questionnaires were modified, translated, combined, and pretested. Participants completed the self-administered questionnaire in a group setting. MAIN RESEARCH VARIABLES Utilization of Pap test screening, health beliefs, and cultural and sociodemographic variables. FINDINGS Sixty-eight percent reported having a Pap test within the prior three years (adherence), and 84% reported ever having a Pap test. The odds of Pap test use and adherence decreased with increasing age. Women with insurance or a regular healthcare provider had better odds of Pap test use and adherence. Older age, older age when a participant moved to the United States, and increased modesty were negatively associated with ever having had a Pap test. CONCLUSIONS Age and cultural beliefs influence Pap test use and adherence. The strength of provider recommendation and healthcare access as predictors suggest areas for interventions designed to increase screening for cervical cancer. INTERPRETATION Nurses play a vital role in preventive health care, especially with the growing number of advanced practice nurses delivering primary care. Primary healthcare providers should be reminded of their influential role in increasing adherence to cancer screening. Further health policy action is necessary to extend screening coverage to those who do not have adequate health insurance.

The reliability and validity of a modified total neuropathy score-reduced and neuropathic pain severity items when used to measure chemotherapy-induced peripheral neuropathy in patients receiving taxanes and platinums

Background: Assessment of chemotherapy-induced peripheral neuropathy signs and symptoms has been hampered because of the lack of simple, reliable, and valid measures. Objective: The study objective was to examine the internal consistency and interrater reliability as well as the structural validity of a 5-component total neuropathy score-reduced (TNSr) variant and a chemotherapy-induced neuropathy-specific Neuropathic Pain Scale. Methods: One hundred seventeen outpatients receiving taxanes or platinums were assessed by a consistent nurse practitioner using the 2 instruments. Ten subjects participated in interrater reliability testing. Results: Mean scores and SDs for individual items were low. The strength item was deleted because of low interitem correlations and a floor effect. The reflex item was deleted because of low interitem correlations and its negative influence on Cronbach &agr;. Pin sensibility was deleted because of low factor loadings. The TNSr-short form and the chemotherapy-induced neuropathy-specific Neuropathic Pain Scale formed 2 distinct factors, providing evidence of structural validity. Cronbach &agr;s for the 2 instruments were .80 and .96, respectively. The TNSr interrater reliability results suggested acceptable rater concordance, but minor revisions could further improve scoring precision. Conclusion: Clinimetric evidence supports the use of 2 new instruments when monitoring taxane- and platinum-related neuropathy and pain. Further instrument modifications are recommended, followed by additional testing in diverse populations. Implications for Practice: With these new instruments, nurses can more easily incorporate prospective neuropathy assessment into daily clinical practice. The outcome will be improved symptom awareness by oncology clinicians and patients, leading to fewer chemotherapy-induced peripheral neuropathy-related devastating effects on functionality and quality of life.

Late-Life Divorce Its Impact on Family Rituals

The impact of late-life divorce on family rituals has not been systematically explored. The purpose of this study was to examine the perceived changes in specific family celebrations, traditions, important life cycle events, and day-to-day family contact that occurred for a group of 115 adult children (73 females and 42 males) whose parents had divorced after a long-term marriage. A strong positive correlation was found between perceived disruptiveness of the parental divorce and changes in family rituals, particularly at Thanksgiving and Christmas. The role of women as kinkeepers, sibling differences, and the implications of evolving family ritual activities for theory development, research, assessment, and intervention are explored.

The Impact of Income Issues and Social Status on Post-Divorce Adjustment of Custodial Parents.

The purpose of this research was to examine the impact of family social status, income amount, source and stability on the social and emotional functioning of 256 divorced custodial parents. Data were collected from personal interviews. A social adjustment scale and a measure of emotional well-being served as the criterion measure of adjustment. The findings obtained suggest that while social status and income level are positively correlated with satisfactory post-divorce adjustment, equivalent incomes do have a differential impact on the custodial parent depending on their source, stability and security. Implications of these findings for practice are discussed.

Elderly cancer survivorship: An integrative review and conceptual framework

UNLABELLED The intersection of ageing and cancer in the phase of post-treatment survivorship represents a large and growing population with unique needs. PURPOSE The goal of this work is to review and integrate the current gerontology and oncology literature relevant to elderly cancer survivorship, to identify knowledge gaps and research opportunities and to propose a conceptual model to guide future research. The long-term, global goal is the prevention of morbidity and mortality in elderly cancer survivors by identification of vulnerable elders, maintenance of independence, tailoring of treatment, establishing intervention guidelines and planning for necessary resources within the entire trajectory of cancer survival for older survivors. METHODS Targeted and integrative review of selected literature from multiple disciplines. Search engines included PubMed, article reference lists and internet searches for epidemiological data (US Census, World Health Organization, American Cancer Society, Canadian Cancer Cancer Society, etc). RESULTS A conceptual model that incorporates the gerontologic, oncologic and personal characteristics of older cancer survivors is proposed that may provide a comprehensive approach by which to frame elderly survivorship research. CONCLUSION Cancer survivorship among the elderly is quantitatively and qualitatively different from cancer survivorship among other age groups. The current large numbers and predicted increase in elderly cancer survivors in the near future mandate attention to this population. Future research must consider the complexity of intersecting needs in the gero-oncology population.

Paths of influence of divorce on preschool children's psychosocial adjustment.

This study examined the direct and indirect influences of parental divorce on preschool childrens psychosocial adjustment through its effect on maternal strain, family socioeconomic status, the quality of the familys interpersonal relationships, and mother-child interaction. Participants included 198 married (n = 99) and divorced (n = 99), predominantly White, lower- to middle-income families with preschool children. Analyses using structural equation modeling (SEM) indicated that family structure and processes in combination most strongly influenced child outcomes. Specifically, the effects of divorce on childrens adjustment were mediated by maternal strain and the quality of mother-child interaction. The goodness-of-fit indices (.90 to .94), root mean square error of approximation index (.03), and nonsignificant chi-square (p = .12) indicated a good fit for the generated structural equation model.

The effect of aging and cancer on the symptom experience and physical function of elderly breast cancer survivors

The majority of cancer survivors are aged ≥65 years, yet, historically, cancer research has focused infrequently on older patients. The objective of this study was to examine predictors of physical function within a framework that integrates the gerontologic and oncologic needs of older cancer survivors.

Measuring Breast Cancer and Mammography Screening Beliefs Among Chinese American Immigrants

Disparities in breast cancer outcomes persist among Asian American women. Breast cancer is the most commonly diagnosed cancer among Chinese American women. This article describes the psychometric evaluation of an instrument measuring knowledge and beliefs related to breast cancer and screening among Chinese American women aged 40 or older. A sample of 100 foreign-born Chinese American women were recruited from an Asian community. Guided by the health belief model, a questionnaire was adapted from three existing questionnaires. Principal axis factoring analyses yielded a three-factor solution that accounted for 53% of the variance in the breast cancer items and a four-factor solution that accounted for 69% of the variance in the cultural items (Cronbachs alphas = .71—.89). Whereas these findings contribute to the understanding of the psychometric properties of an instrument targeted for Chinese American women, additional research is needed to evaluate its utility and efficacy for other Asian Americans.

The Validity of Neuropathy and Neuropathic Pain Measures in Patients With Cancer Receiving Taxanes and Platinums

PURPOSE/OBJECTIVES To assess the validity of neuropathy and neuropathic pain-measurement approaches. DESIGN Cross-sectional measurement study. SETTING Two comprehensive cancer centers in the northeastern United States. SAMPLE 117 patients with cancer in an outpatient setting. METHODS Participants were assessed using the five-component Total Neuropathy Score-reduced (TNSr), the TNSr short form (TNSr-SF), individual TNSr items, the Neuropathic Pain Scale for chemotherapy-induced neuropathy (NPS-CIN), and the National Cancer Institutes Common Toxicity Criteria™, version 3.0 (NCI-CTC). MAIN RESEARCH VARIABLES Neuropathy and pain measure scores, cumulative and per M2 chemotherapy dosage, comorbid risk factors, drug class, and the number of neurotoxic drugs received. FINDINGS TNSr, TNSr-SF, and tendon reflex scores were greater in patients receiving higher cumulative (z range = -2.2 to -3.6; p range = 0.01 to < 0.001) and per M2 (z range = -1.8 to -2.4; p range = 0.04 to < 0.001) chemotherapy doses. Scores from most neuropathy and pain measures were higher in patients with comorbid illnesses (z range = -1.79 to -3.51; p range = 0.03 to < 0.001). Sensory NCI-CTC scores were higher in patients receiving higher cumulative chemotherapy dosage (z = -2.1; p = 0.02). Only the sensory NCI-CTC correlated with other measures (r range = 0.22-0.63; p range = 0.05 to < 0.001). CONCLUSIONS Findings support the validity of the TNSr, TNSr-SF, tendon reflex item, NPS-CIN, and NCI-CTC sensory grading scale when measuring taxane and platinum-induced neuropathy. However, additional validity testing is warranted. IMPLICATIONS FOR NURSING Comprehensive neuropathy and pain measures mainly used by researchers and neurologists were simplified to more clinically useful tools for use by nurses when monitoring chemotherapy-induced peripheral neuropathy.