Ruth Lindquist

Correlates of weight loss and its maintenance over two years of follow-up among middle-aged men

This paper analyzes demographic, social, psychological, and behavioral correlates of weight loss and maintenance in a group of 89 middle-aged men. Measures were collected before and after a 15-week intervention program and at 3-month and 1-year follow-up evaluations. Associations were examined through 2 years of follow-up observation. Principal findings were (a) a strong inverse relationship between prior participation in an organized weight control program and both short- and long-term weight loss; (b) a positive association between efficacy expectations and weight loss; (c) a positive association between attendance at treatment sessions and weight loss; (d) an inverse relationship between spouse attendance and weight loss; and (e) positive associations between weight loss and perceived social support, reported improvement in eating behavior, reported improvement in exercise behavior, and affirmative response to relapse episodes following treatment.

Comparison of Preoperative Characteristics of Men and Women Undergoing Coronary Artery Bypass Grafting (The Post Coronary Artery Bypass Graft [CABG] Biobehavioral Study)

A cohort of 759 coronary artery bypass grafting (CABG) patients (269 women and 490 men) was enrolled in the prospective POST CABG Biobehavioral Study at 5 clinical centers in the United States and Canada. Sociodemographic and medical data were obtained by interview and from medical charts. Health-related quality of life and psychosocial data were ascertained preoperatively by interview and questionnaire for those patients whose condition allowed preoperative assessment and was compared among patients from hospitals enrolling both male and female patients (143 women and 267 men). Women enrolled in the Biobehavioral Study were older than men (65.4 +/- 9.0 vs 61.8 +/- 9.7 years, p < 0.001) and more likely to have a preoperative medical condition which precluded biobehavioral evaluation (47% vs 34%, p < 0.001). Women were less likely to be high school graduates (59% vs 74%, p < 0.001), were less likely to be earning > or =

Comparison of health-related quality-of-life outcomes of men and women after coronary artery bypass surgery through 1 year: findings from the POST CABG Biobehavioral Study.

25,000 per year (39% vs 69%, p < 0.001), and were married less often at the time of surgery (59% vs 85%, p < 0.001). Fewer women than men were able to perform basic self-care activities (p < 0.001) and social activities (p < 0.001). Women were also less able to perform the more demanding activities required for independent living, recreation, and maintaining a household (p < 0.001). Women were also more anxious (p = 0.01) and reported more depressive symptoms (p < 0.001) than men. These data suggest that plans for perioperative and convalescent care for women undergoing CABG should take into account their less favorable medical and psychosocial status relative to men.

Nurse attitudes towards the use of complementary and alternative therapies in critical care

BACKGROUNDnWomen undergoing coronary artery bypass graft (CABG) surgery have a worse medical condition and fewer social and financial resources than men. Some studies have found that women recover less well than men after CABG, whereas others have found womens outcomes comparable to those of men. Past studies of health-related quality of life after CABG have too few women for adequate comparison with men and have not included patients whose data are not available at baseline (eg, emergency CABG), limiting generalizability.nnnMETHODSnA longitudinal study of symptoms and health-related quality of life was conducted among patients from four clinical centers enrolling both men (n = 405) and women (n = 269) in the Post CABG Biobehavioral Study in the United States and Canada.nnnRESULTSnAfter 6 weeks from CABG (average 81 days), both men and women had less anxiety and symptoms related to depression than before surgery (P <.001). After 6 months (average 294 days), both men and women improved in physical and social functioning (P <.001). Although changes in scale scores were similar for men and women at each time point, women scored lower than men on these domains (P <.001, adjusted for baseline medical and sociodemographic differences) and had more symptoms related to depression through 1 year after CABG (P =.003).nnnCONCLUSIONSnBoth male and female patients improve in physical, social, and emotional functioning after CABG, and recovery over time is similar in men and women. However, womens health-related quality-of-life scale scores remained less favorable than mens through 1 year after surgery.

Behavioral treatment of obesity with monetary contracting: Two-year follow-up☆

BACKGROUNDnThere is increasing demand for complementary/alternative therapies (CAT) in critical care, however, critical care nurses perspectives regarding CAT are unknown.nnnOBJECTIVESnThis study was conducted to determine critical care nurses knowledge, attitudes, and use of CAT.nnnSAMPLE/SETTINGnA total of 348 critical care registered nurses working at least 40% in medical, surgical, cardiac, neurological, and pediatric ICUs at 2 tertiary-level hospitals in a large Midwestern city were surveyed. One hospital is a 926-bed private, urban hospital and the second is an 1868-bed academic-affiliated medical center.nnnMETHODSnA survey was distributed to all critical care nurses described above.nnnRESULTSnThe level of knowledge reported by 138 nurse respondents was greatest for diet, exercise, massage, prayer, and music therapy. Use of therapies was related to knowledge and training and consistent with beliefs of legitimacy and perceptions of beneficial effects. Despite barriers including lack of knowledge, time, and training, 88% of respondents were open or eager to use CAT, and 60% reported moderate or greater desire to use CAT.nnnCONCLUSIONSnCritical care nurses are open to CAT use and many use them in their own practice. Because use was associated with knowledge, recommendations for future research include increasing the scientific base and enhancing knowledge to promote evidence-based incorporation of CAT in practice.

Correlates of Caregiver Burden After Coronary Artery Bypass Surgery

Reported is a 2-year follow-up of a behavioral weight reduction program for men using monetary contracts of varying size and group versus individual contingencies. Although initial weight losses were large, in the absence of an effective maintenance program weight losses at two years were modest, similar to those obtained with less effective initial weight loss procedures. Group contracts were significantly more effective in producing long term loss than individual contracts. Reported behaviors associated with weight loss at 2 years are presented.

Personal use of complementary and alternative therapies by critical care nurses

Background: Coronary artery bypass (CAB) patients often rely on spouses for care and assistance during recovery after surgery. Caregiving can be stressful and meaningful depending upon the interplay of many factors not completely understood. These factors may affect the spouse caregivers health-related quality of life (HRQL), which may impact ability to care for the CAB patient. Objective: To investigate patient-spouse caregiver relationship and role variables associated with caregiver burden during the first year after CAB surgery. Methods: Using a cross-sectional design, a convenience sample of CAB spouses was recruited at 3, 6, or 12 months. Spouses (n = 166) completed a survey that included perceptions of patient health status, caregiver burden and other caregiving variables, and caregiver HRQL. Results: Higher burden scores were associated with patients gender (female), poorer patient health status, lower caregiver mental HRQL, increased personal gain, and increased caregiver competence. These correlates explained 38% of the variance in caregiver burden. Discussion: Only poorer patient health status and lower caregiver mental HRQL were supported by previous research in this population. Positive relationships between burden and caregiver competence and personal gain may be a reflection that spouse caregivers were invested and working hard. They felt satisfied from enhancement of self but were burdened from their caregiving role, providing support for a previously described two-domain caregiving model. Caregiver screening is essential to identify spouses at high risk for negative outcomes. Longitudinal research is needed to identify the correlates and predictors most likely to influence burden and caregiver gain over time, and to more fully understand caregiving in the CAB population.

Development of health care delivery systems that are sensitive to the needs of stroke survivors and their caregivers.

Critical care settings are stressful to nurses, and exposure over time may contribute to stress-related symptoms and illnesses. Nurses personal use of complementary and alternative therapies (CAT) may lessen the effects of stress and contribute to their overall well-being and health maintenance. A national survey of critical care nurses who are members of the American Association of Critical-Care Nurses revealed that a majority (96.4%) of critical care nurse respondents were using one or more CAT for personal use or had consulted a provider for CAT therapy. The most common therapies used were exercise, diet, massage, and prayer (or spiritual direction). Nurses personal use of CAT was related to having knowledge of more types of CAT, use of more CAT in practice, a perception of benefits of greater numbers of CAT, more openness to use, more types of CAT recommended to patients, and a perception of more barriers to use in their institutional setting. Data support our model that links nurses personal use to use in practice. Educational programs to promote nurses knowledge and personal use of CAT could lead to an increase in appropriate use of CAT in professional practice and potential benefits to critical care patients and their families.

Sensitivity and specificity of saliva thiocyanate and cotinine for cigarette smoking: A comparison of two collection methods

The life-altering event of a stroke has long-term effects not only on stroke survivors but also on their caregivers, health care professionals, and health care delivery systems. The nurse administrator is faced with an obvious challenge to organize nursing systems to meet the multiple needs of the stroke survivor. The article presents data on the perceived needs of stroke survivors and their caregivers that provide direction and assistance to nursing administrators in organizing nursing services to address these perceived needs.

Nursing's role in complementary and alternative therapy use in critical care

Saliva samples returned by mail were compared to duplicates returned by interviewers in terms of the sensitivity and specificity of cotinine and thiocyanate analyses performed on those samples to detect tobacco use. Compared to the samples returned by interviewers, those returned through the mail were slightly lower in specificity but similar in sensitivity. These findings confirm that saliva samples do not deteriorate during transit via the postal service, although substantial questions remain that concern the validity of such samples in the evaluation of cessation programs.