Mona N. Wicks

Chronic Disease Self-Management Improved with Enhanced Self-Efficacy

This pilot study used a quasi-experimental pretest-posttest design to examine if participation in a chronic disease self-management program (CDSMP) improved self-efficacy, self-efficacy health, and self-management behaviors in anunderserved, poor, rural population. The sample, recruited from two clinics in a south central state, consisted of 48 adults (59.70 11.22 years) and was 79.2% Caucasian (n = 38) and 20.8% (n = 10) African American. Trained lay leaders with chronic illnesses directed the interactive CDSMP based on Bandura’s selfefficacy theory that included strategies for personal exercise program development, cognitive symptom management, problem solving, and communication skills. Program-specific paper-and-pencil instruments were completed prior to and immediately after completion of the 6-week program. Significant improvements (p < .10) in self-efficacy, self-efficacy health, and self-management behaviors occurred. Results underscore the need to evaluate intervention programs for specific populations and for a new paradigm that focuses on patient-provider partnerships that can improve health outcomes in underserved, poor, rural populations.

Caregiver attributes as correlates of burden in family caregivers coping with chronic obstructive pulmonary disease

The subjective burden that occurs in family caregivers of patients diagnosed with chronic obstructive pulmonary disease (COPD) may be related to specific caregiver attributes. In a sample of 138 family caregivers of 138 patients diagnosed with COPD, Black caregivers experienced less burden than did their White counterparts, and caregivers younger than 55 years of age experienced more burden than did older caregivers. Similar levels of burden occurred in male versus female and spouse versus nonspouse caregivers. In addition, the subjective burden did not differ by caregiver education, perceived financial adequacy, or employment status. Clinicians cognizant of the relationship between contextual factors, such as caregiver age and caregiver burden, are better prepared to provide appropriate care that may optimize family caregiver and, indirectly, chronic care patients’ outcomes.

LENGTH OF STAY, ADMISSION TYPES, PSYCHIATRIC DIAGNOSES, AND THE IMPLICATIONS OF STIGMA IN AFRICAN AMERICANS IN THE NATIONWIDE INPATIENT SAMPLE

African Americans purportedly have a higher prevalence of mental illnesses but are often misdiagnosed and less likely to seek treatment. Delayed treatment has been associated with the stigma related to these disorders. The demographic characteristics, length of stay, most prevalent psychiatric diagnoses, and hospital admissions of African Americans were compared to other U.S. populations using a nationwide sample (N = 4,474,732). African American participants were younger, had significantly longer lengths of stay, and were admitted more often through the emergency room than the other groups in this sample. Psychosis, alcohol/drug dependence, and depressive neurosis were the most prevalent psychiatric diagnoses reported for African American participants. Research is needed to explain these results so that strategies can be instituted to improve the poor mental health outcomes often observed in African American populations.

Cardiovascular Dysautonomia of Patients With End-Stage Renal Disease and Type I or Type II Diabetes

BACKGROUND End-stage renal disease and diabetes mellitus are known to cause autonomic dysfunctions that are responsible for poor outcomes. Studies suggest that 24-hour heart rate variability with power spectral analysis is more sensitive to early changes in autonomic function than laboratory-evoked measures. OBJECTIVES To evaluate cardiovascular autonomic function in patients (a) awaiting kidney or pancreas-kidney transplantation, (b) without diabetes (NonDM), (c) with Type I insulin dependent diabetes mellitus (IDDM), and (d) with Type II noninsulin dependent diabetes mellitus (NIDDM), and to compare the results of the laboratory-evoked cardiovascular autonomic tests with those from 24-hour heart rate variability monitoring with power spectral analysis. METHOD This cross-sectional study examined autonomic function in prekidney transplant patients with and without diabetes (N=96), comparing laboratory-evoked measures to 24-hour measures. RESULTS The nondiabetic group had a normal change in heart rate with deep breathing, Valsalva ratio, and change in systolic blood pressure with tilt. Both diabetic groups had poorer values for all measures of heart rate variability; demonstrated abnormal changes in heart rate with deep breathing and borderline Valsalva ratios; demonstrated a greater decrease in circadian rhythmicity; and had lower SDNNS, pNN50s, and rMSSDs than the nondiabetic group. CONCLUSIONS Results showed that 24-hour measures are more sensitive, that patients with end-stage renal disease and diabetes regardless of type experience significantly poorer function than do patients without diabetes, and that these values approach those associated with sudden cardiac death.

Immunosuppressant side effect profile does not differ between organ transplant types

Transplantation has enhanced the quality of life of all transplant recipients, but concern remains regarding the side effects of immunosuppressant drugs. In order to respond to these concerns, a survey to ascertain the side effect profile of transplant recipients was undertaken to identify the impact of chronic immunosuppression on quality of life. A nationwide survey of solid organ transplant recipients was carried out using a newly developed immunosuppressant side effect survey. Kidney, kidney–pancreas, liver and heart recipients responded to the survey (n=505) and reflect the national distribution based on the UNOS data for organ type, recipient race and gender. The survey had four subscales: emotional burden, life/role responsibilities, mobility and GI distress. A fifth subscale included miscellaneous side effects that are more prevalent during the first 2 years post‐transplant. Frequency and severity of each side effect were coded on a scale of 0–4 from ‘no problem’ to ‘always’ a problem. The entire range of possible scores (0–160) was reported, reflecting adequate variability in the responses. The sample consisted of 51% males, 77% Caucasians, 15% African Americans, with the remaining 8% other races. There were 225 (44.5%) kidney, 147 (29.1%) liver, 101 (20%) heart and 32 (6.4%) pancreas included. Age ranged from 18–71 years with time since transplant 1–21 years. Overall frequency (12.1±6.08), severity (10.5±6.96) and weighted scores (25.4±19.9) were low suggesting that, as a whole, immunosuppressant side effects, while present, were not severe or troublesome for most patients. Side effect profiles appeared similar among organ types. Differences were detected in the GI distress subscale with the heart recipients reporting significantly less GI distress than liver recipients (13.8 vs. 19.2; P<0.05). Side effect impact on mobility tended to increase between time eras; however, no statistical significance was detected. Side effects are a concern among health‐care professionals; however, based on the results of this study, immunosuppressant‐related side effects are not detrimental to quality of life and show no differences between types of organ transplanted.

A Test of the Wicks Family Health Model in Families Coping with Chronic Obstructive Pulmonary Disease

This study used the Wicksfamily health model to test relationships among family health and time since diagnosis, perception of symptom severity, caregiver stress, and family stressors in 140families coping with chronic obstructive pulmonary disease. Hypotheses were tested using Pearsons correlation coefficients and hierarchical multiple regression analysis. Family health was influenced by time since diagnosis, patient perceptions of symptom severity, caregiver stress, and family stressors as predicted. Cognitive impairment (patient-reported poor memory) was the only symptom significantly influencing family health. Even when physicalfrailty is the hallmark of a disease, it may be the cognitive aspects of the disease that strain family relationships.

Sustained improvements in cardiac geometry and function following kidney-pancreas transplantation.

Kidney–pancreas (KP) transplantation has been shown to improve left ventricular (LV) geometry and function 6–24 months after the procedure, yet whether these improvements are sustained in long-term survivors has not been demonstrated. This study examined whether early improvements in LV geometry and function were sustained 3–5 years after KP transplantation. Left ventricular function and geometry were prospectively evaluated prior to, and at 1, 2, and 3–5 years posttransplant using two-dimensional, M-mode, echocardiography with Doppler interrogation in the parasternal and apical views. The sample included 21 KP and a comparison group of 12 diabetic kidney-alone (KA) recipients. Long-term (3–5 years) data were obtained for KP recipients only. Although KA recipients had a longer duration of dialysis and worse diastolic function pretransplant, the groups were similar on other baseline measures. KA recipients experienced minimal improvements while KP recipients had significant improvements in cardiac function and geometry, both in terms of mean values and the percentage of KP recipients who experienced normalization posttransplant (p < 0.05). KP recipient improvements were also sustained at 3–5 years posttransplant on three of five measures, with 75% of long-term KP recipients achieving normal LV mass posttransplant compared with 31% pretransplant. Data indicate that significant impairments in cardiac geometry and function occur in diabetic KA and KP recipients. Though both groups experienced early improvements posttransplant, KP recipients achieved more dramatic and clinically significant improvements at 1, 2, and 3–5 years posttransplant. Additional studies are needed to examine the relevance of these findings with regard to the cardiac morbidity and mortality of these patients.

Characterizing dietary intake and physical activity affecting weight gain in kidney transplant recipients

Context— Weight gain after kidney transplantation affects 50% to 90% of kidney transplant recipients. Factors leading to weight gain in recipients are thought to include a change in lifestyle (eg, dietary intake and physical activity), age, race, sex, and immunosuppressant medications. Objective— To examine dietary intake and physical activity of kidney transplant recipients at baseline and 3 and 6 months after transplantation to identify contributing factors to weight gain. Design— Descriptive, correlational study using secondary data from a larger parent study examining genetic and environmental contributors to weight gain after kidney transplantation. Participants and Setting— Forty-four kidney transplant recipients at a mid-South university hospital-based transplant institute who had dietary intake, physical activity, and clinical data at baseline and 3 and 6 months were included. Main Outcome Measures— Dietary intake, physical activity, weight, and body mass index. Results— Mean weight gain increased by 6% from baseline to 6 months. Interestingly, dietary intake did not change significantly from baseline to 6 months. Hours of sleep per day decreased during the same period (P = .02). Dietary intake, physical activity, age, race, sex, and immunosuppression showed no significant relationship to weight gain at 6 months. Conclusion— Little consideration has been given to dietary intake and physical activity of kidney transplant recipients and the effects of these variables on weight gain. Further studies with a larger sample are needed, as weight gain after transplantation is a significant risk factor for diminished long-term outcomes.

Religiosity, Self-Efficacy for Exercise, and African American Women

Physical inactivity among African American women persists despite health promotion efforts targeting this population. In the African American faith community, thinking patterns related to personal versus divine control over health status could affect self-efficacy beliefs and physical activity behavior. Religiosity, a determinate of self-efficacy for exercise, is influenced by culture. This exploratory pilot study assessed the psychometric properties and relevance of selected study instruments and relationships among the study variables in African American women recruited through a rural church. Findings indicated a trend toward significance among study variables and that the God Locus of Health Control and Physical Exercise Self-Efficacy Scales were reliable for capturing attitudes about ability to engage in physical activity and religiosity in this sample. Six of the twenty-five women recruited failed to complete the Stanford Brief Activity Survey for Work and Leisure Time Activity correctly, suggesting the need to revise instructions prior to future instrument administration.

A pilot study of the self-reported quality of life for patients with chronic obstructive pulmonary disease

BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) experience significant impairment in their quality of life (QOL). However, relatively few studies have examined overall and global QOL in patients with COPD using both generic QOL and health-related quality of life (HRQOL) measures. PURPOSE The purposes of this pilot study were to describe the self-reported QOL (overall and global), disease-specific HRQOL, depressive symptoms, and disease-specific symptoms and experiences of patients with COPD and to examine the relationship among disease-specific HRQOL, depressive symptoms, disease-specific symptoms and experiences, and QOL (overall and global) in patients diagnosed with moderate to severe COPD. METHODS A descriptive correlational design was used. Thirty-six participants completed overall QOL, global QOL, disease-specific HRQOL, depressive symptoms, and disease-specific symptoms and experiences questionnaires. RESULTS Overall QOL was low; global QOL was at the median of scale range. Overall QOL scores were significantly correlated with the disease-specific St George Respiratory Questionnaire total score, symptoms and impact subscale, depressive symptoms, and 7 Bronchitis Emphysema Symptom Checklist subscales. CONCLUSION Findings provided partial support for the association between QOL and disease-specific HRQOL and the usefulness of disease-specific questionnaires when assessing QOL.