Michele Montgomery

Medical screening participation in the childhood cancer survivor study.

BACKGROUND Despite their risk for serious late sequelae, survivors of childhood cancer do not adhere to recommended medical screening guidelines. We identified treatment, survivor, physician, and contextual factors that may influence survivor adherence to recommended echocardiography and bone densitometry screening. METHODS Structural equation modeling of data from the Childhood Cancer Survivor Study; 838 participants had received a diagnosis of and were treated for pediatric cancers between 1970 and 1986. RESULTS Survivors at risk of cardiac sequelae (n = 316; mean [SD] age, 31.01 [7.40] years; age at diagnosis, 9.88 [5.88] years; and time since diagnosis, 21.14 [4.37] years) who reported more cancer-related visits (P = .01), having discussed heart disease with a physician (P < or = .001), with a sedentary lifestyle (P = .05), and less frequent health fears (P = .05) were most likely to follow the recommended echocardiogram schedule (R(2) = 23%). Survivors at risk of osteoporosis (n = 324; age, 30.20 [7.09] years; age at diagnosis, 9 .01 [5.51]years; and time since diagnosis, 21.20 [4.27] years) who reported more cancer-related visits (P = .05), were followed up at an oncology clinic (P = .01), had discussed osteoporosis with a physician (P < or = .001), and had a lower body mass index (P = .05) were most likely to adhere to the recommended bone density screening guidelines (R(2) = 26%). Symptoms and motivation influenced screening frequency in both models. CONCLUSIONS Multiple factors influence survivor adherence to screening recommendations. It is likely that tailored interventions would be more successful in encouraging recommended screening in survivors of childhood cancer than would traditional health education approaches.

PHYSICAL THERAPY AND CHIROPRACTIC USE AMONG CHILDHOOD CANCER SURVIVORS WITH CHRONIC DISEASE: IMPACT ON HEALTH-RELATED QUALITY OF LIFE

IntroductionThe use of rehabilitation services to address musculoskeletal, neurological and cardiovascular late effects among childhood cancer survivors could improve physical function and health-related quality-of-life (HRQL). We describe physical therapy (PT) and chiropractic utilization among childhood cancer survivors and their association with HRQL.MethodsThe sample included 5+ year survivors from the Childhood Cancer Survivor Study (N = 9,289). Questions addressing use of PT or chiropractic services and HRQL (Medical Outcomes Survey Short Form (SF-36)) were evaluated. Multivariable regression models compared PT and/or chiropractic utilization between survivors and siblings, and by diagnosis, treatment and demographic characteristics; associations between chronic disease, PT/chiropractic use, and HRQL were similarly evaluated.ResultsSurvivors were not more likely to use PT (OR 1.0; 95% CI 0.8–1.2) or chiropractic (OR 0.8; 95% CI 0.7–1.0) services than siblings. More survivors reported using chiropractic (12.4%) than PT (9.2%) services. Older age and having health insurance were associated with utilization of either PT or chiropractic services. Grade 3-4 chronic conditions and a CNS tumor or sarcoma history were associated with PT but not with chiropractic service utilization. Survivors with musculoskeletal (OR 1.8; 95% CI 1.1–2.9), neurological (OR 3.4; 95% CI 1.6–6.9), or cardiovascular (OR 3.3; 95% CI 1.6–6.9) chronic conditions who used PT/chiropractic services were more likely to report poor physical health than survivors who did not use services.ConclusionsThe reported prevalence of PT/chiropractic among survivors is consistent with that reported by siblings. Severity of late effects is associated with service use and with reporting poor physical health.Implications for Cancer SurvivorsLong-term childhood cancer survivors do not appear to utilize rehabilitation services to optimize physical function and support increased HRQL.

Cardiovascular Risk Factors and Use of Health Care Services in Low-Income, Minority Preschool Children

Background. The association between weight, blood pressure, and use of health care services is not well understood in low-income, preschool children. Methods. This study was a secondary data analysis of previously collected data. Body mass index (BMI) and blood pressure were collected during health screenings, and information regarding use of health care services was collected by parent report. Results. Of the 660 children screened, 22.1% of the sample was classified as obese and 15.2% were considered overweight. Obese children had significantly more doctor’s visits than both overweight and normal weight children. Systolic blood pressure (SBP) also emerged a significant predictor of number of doctor’s visits within the last year. Neither were significantly associated with emergency department visits or hospitalizations. Conclusion. This study provides evidence that lowincome, preschool children have high rates of obesity. It also provides new information regarding the association between obesity, SBP, and physician visits in this population.

The Presence of Risk Factors for Type 2 Diabetes Mellitus in Underserved Preschool Children

This study identified risk factors (ie, high-risk racial/ethnic group, overweight/obesity, elevated blood pressure, elevated casual blood glucose, and the presence of acanthosis nigricans) for the development of type 2 diabetes mellitus (T2DM) in underserved children with or without a family history of diabetes during annual preschool health screenings. Early identification of risk factors for the development of T2DM will allow for effective interventions to be implemented, thus, improving the long-term health-related quality of life of at-risk children.

Family health history and future nursing practice: Implications for undergraduate nursing students

• A complete and accurate family health history is an integral part of providing comprehensive care.

Incorporating End-of-Life Content Into the Community Health Nursing Curriculum Using High-Fidelity Simulation

Because nurses are the healthcare providers who spend the most time with patients and their families at the end of life, baccalaureate nursing students should be adequately prepared for this role before they graduate. However, many undergraduate nursing programs fail to provide adequate end-of-life content, and many undergraduate nursing students often do not have the opportunity to care for dying patients during clinical rotations. Faculty in an undergraduate community health nursing course incorporated an end-of-life clinical experience using high-fidelity patient simulation to allow students to provide holistic care to a dying patient and his family in a safe learning environment. The simulator was used to play the role of the dying patient, and a course faculty member acted as the patient’s daughter. Students were given the role of the hospice nurse. At the end of the experience, students expressed a greater understanding of the pathophysiology at the end of life, as well as enhanced communication skills. Because many nursing students may not encounter an actively dying patient during their clinical rotations, high-fidelity patient simulation is an effective mechanism for providing students with exposure to end of life.

Increasing Nursing Students’ Knowledge of Health Promotion Through Community Engagement

The shift in health care toward primary health care and health promotion requires nurse educators to ensure students learn to practice the skill of health promotion. An ideal way in which to do this is with collaborative partnerships in community settings. The need to practice primary health care as part of an interprofessional team is also a growing trend. This article describes an innovative collaborative partnership with the city school system and nonprofit community partners to provide necessary interprofessional health screenings and health education to underserved community members. Through these partnerships, community health nursing students have the opportunity to participate in health screenings for children enrolled in the preschool program, provide health screenings and health education to healthy working adults, and engage in health promotion with school-age children by teaching the importance of practicing bicycle safety. These programs provide nursing students with unique opportunities for interprofessional collaboration while improving their health promotion, teaching, and communication skills. This approach serves as a model to guide nursing faculty members who need to provide students community health experiences that include health promotion and disease and injury prevention.

Elevated Blood Pressure in Low-Income, Rural Preschool Children is Associated with Maternal Hypertension during Pregnancy

ABSTRACT Hypertension (HTN) is a significant public health problem in adults, and rates of HTN are rising in children as well. The purpose of this study was to determine blood pressure (BP) and body mass index (BMI) levels in low-income, rural preschool children and investigate the relationship between child and maternal factors that impact BP and BMI in these children. Results indicated high rates of overweight/obesity and elevated BP levels in this sample. Maternal hypertension during pregnancy also emerged as a predictor of elevated BP in their children.