Susan McCrone

Chronic obstructive pulmonary disease, anxiety, and depression: State of the science

BACKGROUND Chronic obstructive pulmonary disease (COPD) affects millions worldwide. Despite advances in the treatments of other chronic diseases, little progress in decreasing COPD morbidity and mortality has been made. The death rate associated with COPD has doubled in 30 years. The presence of psychiatric comorbidities, such as anxiety and depression, has been linked to increased mortality, decreased functional status, and decreased quality of life. OBJECTIVE This review was undertaken to determine the state of the science of COPD, anxiety, and depression, and to identify nursing implications derived from these findings. CONCLUSION Although the prevalence of anxiety and depression among patients with COPD is significantly higher than the general population, there are serious barriers to the recognition and treatment of these comorbid conditions. Routine assessment and screening for anxiety and depression in all patients diagnosed with COPD should be considered.

Psychological distress associated with the diagnostic phase for suspected breast cancer: systematic review

AIM This paper is a report of a review conducted to define the manifestations that characterize psychological distress during the diagnostic phase for suspected breast cancer, define the extent of psychological distress associated with the threat of potential cancer, and identify factors influencing psychological distress levels. BACKGROUND Raising the possibility that a malignancy might be present is threatening. The resulting distress is believed to influence treatment outcomes in those diagnosed with cancer and result in behavioural changes in those with benign disease. DATA SOURCES Research papers published between January 1983 and May 2009 were identified in CINAHL, MEDLINE and PsycINFO. The search was performed using the following terms: breast cancer diagnosis, mammography, breast biopsy, breast diagnostic, anxiety, distress and uncertainty. REVIEW METHODS A systematic review was conducted of 30 studies meeting the inclusion criteria of a quantitative design with at least one standardized measure of distress and specifically addressing distress during the evaluation period. RESULTS It is well-documented that distress, manifested as anxiety, exists. In a small cohort of women, distress levels are heightened to worrying levels that may have long-term implications. There was strong evidence for relationships among medical history, education and trait anxiety with distress. There was no substantiation of the association between younger age and increased psychological distress that has been consistently reported with other cancers. CONCLUSION It is necessary to understand the impact of factors on distress so that heightened levels can be predicted and targeted by interventions initiated at the first mention of the possibility of the presence of malignancy.

The maternal experience of having diabetes in pregnancy

Purpose: To describe the maternal experience of having type 2 or gestational diabetes in pregnancy using focus groups and individual telephone interviews. Data sources: Eight women who had type 2 or gestational diabetes in at least one pregnancy and participated in the qualitative study addressing the open‐ended guiding questions on their experience. Conclusions: This phenomenological study gave voice to the womens experience with and concerns about having diabetes in pregnancy. Three primary themes emerged and were identified: (a) feeling concern for the infant related to diabetes, (b) feeling concern for self related to diabetes, and (c) sensing a loss of personal control over their health. Subthemes for each of the primary themes were also identified. Implications for practice: The experiences shared by these women may serve to inform the development of interventions aimed at meeting the needs of women with diabetes in pregnancy. By learning from the themes of the phenomenological study, advance practice nurses may anticipate the needs of the women diagnosed with diabetes in pregnancy to augment their care, education, and promotion of diabetes self‐management in pregnancy.Purpose: To describe the maternal experience of having type 2 or gestational diabetes in pregnancy using focus groups and individual telephone interviews. Data sources: Eight women who had type 2 or gestational diabetes in at least one pregnancy and participated in the qualitative study addressing the open-ended guiding questions on their experience. Conclusions: This phenomenological study gave voice to the womens experience with and concerns about having diabetes in pregnancy. Three primary themes emerged and were identified: (a) feeling concern for the infant related to diabetes, (b) feeling concern for self related to diabetes, and (c) sensing a loss of personal control over their health. Subthemes for each of the primary themes were also identified. Implications for practice: The experiences shared by these women may serve to inform the development of interventions aimed at meeting the needs of women with diabetes in pregnancy. By learning from the themes of the phenomenological study, advance practice nurses may anticipate the needs of the women diagnosed with diabetes in pregnancy to augment their care, education, and promotion of diabetes self-management in pregnancy.

Review of Interventions to Reduce Stress Among Mothers of Infants in the Nicu

Nearly half a million preterm infants are born each year in the United States. Preterm delivery has significant psychosocial implications for mothers, particularly when their baby spends time in the neonatal intensive care unit (NICU). The decrease in length of gestation causes mothers to have to parent prematurely, without the less time for emotional preparation than mothers of full-term infants. Parents of NICU infants experience stress related to feelings of helplessness, exclusion and alienation, and lack sufficient knowledge regarding parenting and interacting with their infants in the NICU. There are a number of interventions that nurses can do that help reduce the stress of mothers of infants in the NICU.

Age Distribution and Risk Factors for the Onset of Severe Disability Among Community-Dwelling Older Adults with Functional Limitations

This study examines age distribution and risk factors for the onset of severe disability among community-dwelling older adults with functional limitations. Data were obtained from the initial community-dwelling sample (n = 6,088) of the National Long-Term Care Survey in 1982 and the follow-up interviews in 1984, 1989, 1994, and 1999. Multiple proportional hazard regression was conducted using age at onset of severe disability as the dependent variable. Explanatory variables included chronic diseases and sociodemographic and personal characteristics. Of the 3,485 elders who were not severely disabled initially, 1,364 were identified as developing severe disability over time. The onset age ranged from 66 to 109 years with the peak occurring at 82 to 83 years. The predictors for earlier onset of severe disability were paralysis, arthritis, obesity, hypertension, and middle education level (Grades 9-12). These findings provide practical implications for identifying at-risk individuals and developing health behavior interventions to delay onset of severe disability.

Cookin' Up Health: developing a nutrition intervention for a rural Appalachian population.

Cookin’ Up Health is a culturally targeted and individualized tailored nutrition intervention using a computerbased interactive format. Using a cooking show theme, the program demonstrates step-by-step meal preparation emphasizing healthy selection and portion control. Focus groups were conducted with women in two rural counties in West Virginia to guide the development of the intervention. Women felt more susceptible to heart disease because the changing role of women creates more stress and less time; weight loss was a greater motivator for dietary change than was preventing heart disease; social support is a barrier and facilitator for dietary change; cultural heritage and the way women were raised were major barriers to making health changes as adults; convenience and the cost of eating healthier were major factors when trying to make changes in diet; and women did not feel confident in their ability to maintain dietary changes.

An Integrative Review of Correlates and Predictors of Depression in Patients with Rheumatoid Arthritis

Depression creates an additional burden for adults with rheumatoid arthritis (RA), negatively affecting disease outcomes and quality of life. An integrative literature review of twenty-three quantitative studies was conducted on correlates and factors predictive of depression in adults with RA. Methodological assessment tools were used to independently evaluate the data quality by two reviewers. Prevalence rates ranged from 6.6 to 66.25%. Correlates included pain, functional status, disease duration, and RA treatment. Predictors, including sociodemographics, pain, coping ability, support, functional status, and clinical factors, varied depending upon the sample, standardized measure, and geographic location. Understanding correlates/predictors could guide the development of comprehensive care.

Health Behaviors and Transitions of Physical Disability Among Community-Dwelling Older Adults

This study examined the transitions of disability over 5 years among older adults and the influences of health behaviors on these transitions. Data was obtained from the community cohort of the National Long-Term Care Survey in 1994 (n = 5,089) and their follow-up data in 1999. Generalized logit regressions revealed that obesity increased the risk of disability. Light drinking decreased the risk of disability. Among disabled individuals, the risk of status decline was higher for those underweight or physically inactive, and those taking vitamin and/or mineral supplements regularly or working on a hobby were less likely to further decline in the disability statuses. In an older population, having more contacts with friends, having regular social activities, and having a body mass index ≥ 25 were beneficial to survival. These findings indicate that older adults may have greater personal control over their lives based on their choices about lifestyles and social connections.

SRD5A1 Genotype Frequency Differences in Women with Mild versus Severe Premenstrual Symptoms

The aims of this small pilot study were to explore the association between premenstrual symptom severity and two genes from the gamma-aminobutyric acid (GABA) pathway: steroid-5-alpha-reductase, alpha polypeptide 1 (SRD5A1) and gamma-aminobutyric acid receptor subunit alpha-4 (GABRA4). Saliva samples were obtained from a convenience sample of 19 Caucasian females ages 18–25 years, ten cases and nine controls. Deoxyribonucleic acid (DNA) was isolated, and genotyping performed on ten single nucleotide polymorphisms (SNPs). Ten percent of cases and 44% of controls had the cytosine/cytosine (C/C) genotype for the SRD5A1 SNP, rs501999 indicating that this genotype may protect women against severe premenstrual symptoms. Replication of this study using an adequately powered sample size is warranted.

Effectiveness of continuous glucose monitoring in children, adolescents, and young adults with poorly controlled type 1 diabetes.

OBJECTIVE The purpose of this study was to determine the effect of continuous glucose monitoring (CGM) on glycemic control in children, adolescents, and young adults ages 7-21 years with poorly controlled diabetes HbA1c 9.0% or more (74 mmol/mol IFCC). MATERIALS AND METHODS The primary outcome was improvement in HbA1c. The secondary outcome included self-reported hypoglycemia. This 12-week study used a prospective, one-group, pre- and posttest pre-experimental design with a convenience sample. The study used the Medtronic Guardian CGM with Enlite Sensor. RESULTS AND CONCLUSIONS Thirty-three subjects enrolled in the study. The mean age of the participants was 15.57 years, range was 11-20 years, 47.6% were male, and 52.4% were female. Twenty-one (63.6%) completed the final study visit. There was a clinically and statistically significant reduction of 1.46 (SD = 1.6711) (p = .001) in HbA1c at 12 weeks. Fifteen of the 21 participants (71.4%) had an HbA1c reduction of greater than 0.5%. The CGM monitor was worn a mean of 4.262 days a week. None of the subjects reported significant hypoglycemia while wearing the monitor. CGM was effective in improving glycemic control in this population with poorly controlled diabetes.