Versie Johnson-Mallard

Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer

Objectives: Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period.

Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors.

Purpose: To assess the feasibility of whether mindfulness-based stress reduction (MBSR) has a positive effect on breast cancer survivors’ psychological status, psychosocial characteristics, symptoms, and quality of life (QOL) during the critical transition period from end of treatment to resumption of daily activities. Design: Single-group, quasi-experimental, pretest—posttest design. Method: A sample of 19 women who completed breast cancer treatment with lumpectomy, radiation, and/or chemotherapy was recruited from the Moffitt Cancer Center and Research Institute, a National Cancer Institute— designated cancer center, and the University of South Florida. The authors assessed the feasibility, compliance, and whether an 8-week MBSR program positively influenced changes in psychological status (fear of recurrence, perceived stress, anxiety, depression), psychosocial characteristics (optimism, social support, spirituality), physical symptoms, and QOL. Findings: Seventeen women (89.5%) completed the study. The mean age was 57 years; the majority of participants (94%) were White. The estimated compliance rate for the program was 67%. Paired t tests indicated significant improvements fear of recurrence, perceived stress, anxiety, depression, and QOL through MBSR participation. Conclusions: Participants enrolled in the MBSR classes generally were compliant. Significant improvement in psychological status, symptoms, and QOL can be achieved with MBSR use in this population.

Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial

PURPOSE The purpose of this randomized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program in improving psychological and physical symptoms and quality of life among breast cancer survivors (BCSs) who completed treatment. Outcomes were assessed immediately after 6 weeks of MBSR(BC) training and 6 weeks later to test efficacy over an extended timeframe. PATIENTS AND METHODS A total of 322 BCSs were randomly assigned to either a 6-week MBSR(BC) program (n = 155) or a usual care group (n = 167). Psychological (depression, anxiety, stress, and fear of recurrence) and physical symptoms (fatigue and pain) and quality of life (as related to health) were assessed at baseline and at 6 and 12 weeks. Linear mixed models were used to assess MBSR(BC) effects over time, and participant characteristics at baseline were also tested as moderators of MBSR(BC) effects. RESULTS Results demonstrated extended improvement for the MBSR(BC) group compared with usual care in both psychological symptoms of anxiety, fear of recurrence overall, and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference (P < .01). Overall effect sizes were largest for fear of recurrence problems (d = 0.35) and fatigue severity (d = 0.27). Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC). CONCLUSION The MBSR(BC) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC) training, with generally small to moderate overall effect sizes.

Lymphocyte Recovery After Breast Cancer Treatment and Mindfulness-Based Stress Reduction (MBSR) Therapy

Objectives: This randomized controlled trial was conducted to examine immune recovery following breast cancer (BC) therapy and evaluate the effect of mindfulness-based stress reduction therapy (MBSR) on immune recovery with emphasis on lymphocyte subsets, T cell activation, and production of T-helper 1 (Th1; interferon [IFN]-γ) and T-helper 2 (Th2; interleukin-4 [IL-4]) cytokines. Method: Participants who completed the study consisted of 82 patients diagnosed with Stage 0–III BC, who received lumpectomy and adjuvant radiation ± chemotherapy. Patients were randomized into an MBSR(BC) intervention program or a control (usual care) group. Immune cell measures were assessed at baseline and within 2 weeks after the 6-week intervention. The numbers and percentages of lymphocyte subsets, activated T cells, and Th1 and Th2 cells in peripheral blood samples were determined by immunostaining and flow cytometry. Results: Immune subset recovery after cancer treatment showed positive associations with time since treatment completion. The B and natural killer (NK) cells were more susceptible than T cells in being suppressed by cancer treatment. Women who received MBSR(BC) had T cells more readily activated by the mitogen phytohemagglutinin (PHA) and an increase in the Th1/Th2 ratio. Activation was also higher for the MBSR(BC) group if <12 weeks from the end of treatment and women in MBSR(BC) <12 weeks had higher T cell count for CD4+. Conclusion: MBSR(BC) promotes a more rapid recovery of functional T cells capable of being activated by a mitogen with the Th1 phenotype, whereas substantial recovery of B and NK cells after completion of cancer treatment appears to occur independent of stress-reducing interventions.

Initial evaluation of the Robert Wood Johnson Foundation Nurse Faculty Scholars program

BACKGROUND The Robert Wood Johnson Foundation Nurse Faculty Scholars (RWJF NFS) program was developed to enhance the career trajectory of young nursing faculty and to train the next generation of nurse scholars. Although there are publications that describe the RWJF NFS, no evaluative reports have been published. The purpose of this study was to evaluate the first three cohorts (n = 42 scholars) of the RWJF NFS program. METHODS A descriptive research design was used. Data were derived from quarterly and annual reports, and a questionnaire (seven open-ended questions) was administered via Survey Monkey Inc. (Palo Alto, CA, USA). RESULTS During their tenure, scholars had on average six to seven articles published, were teaching/mentoring at the graduate level (93%), and holding leadership positions at their academic institutions (100%). Eleven scholars (26%) achieved fellowship in the American Academy of Nursing, one of the highest nursing honors. The average ratings on a Likert scale of 1 (not at all supportive) to 10 (extremely supportive) of whether or not RWJF had helped scholars achieve their goals in teaching, service, research, and leadership were 7.7, 8.0, 9.4, and 9.5, respectively. The majority of scholars reported a positive, supportive relationship with their primary nursing and research mentors; although, several scholars noted challenges in connecting for meetings or telephone calls with their national nursing mentors. CONCLUSIONS These initial results of the RWJF NFS program highlight the success of the program in meeting its overall goal-preparing the next generation of nursing academic scholars for leadership in the profession.

Pap Test Adherence, Cervical Cancer Perceptions, and HPV Knowledge Among HIV-Infected Women in a Community Health Setting

&NA; The Health Belief Model (HBM) has been widely used as a framework to explain health behaviors in diverse populations, but little HBM research has focused on HIV‐infected women and their increased risks for cervical cancer. We used Champions Health Belief Model and Self‐Efficacy scales to assess relationships between Pap test adherence and constructs of the HBM among 300 HIV‐infected women. In addition, we assessed the relationship between HPV and cervical cancer knowledge and key HBM concepts. Participants reported low levels of knowledge regarding risk for cervical cancer and HPV. They perceived lower personal risk for cervical cancer. Women with higher perceived self‐efficacy and lower perceived barrier scores reported better Pap test adherence. Findings indicate that HIV‐infected women are not aware of the risk for cervical cancer and may not take preventive actions. Further research is needed to identify the full range of factors that impact adherence to cervical cancer screening.

Young Hispanic Men and Human Papillomavirus Vaccination Choices

This exploratory descriptive study examined perceived vulnerabilities to human papillomavirus (HPV) and the correlation to factors influencing vaccine beliefs and vaccine decision making in young Hispanic males attending a large public urban university. Only 24% of participants believed that the HPV vaccine could prevent future problems, and 53% said they would not be vaccinated. The best predictors of HPV vaccination in young Hispanic men were agreement with doctor recommendations and belief in the vaccine’s efficacy. Machismo cultural norms influence young Hispanic men’s HPV-related decision making, their perceptions of the vaccine, and how they attitudinally act on what little HPV information they have access to. This study provides culturally relevant information for the development of targeted health education strategies aimed at increasing HPV vaccination in young Hispanic men.

Breaking down silos: The future of sexual and reproductive health care—An opinion from the women's health expert panel of the American Academy of Nursing

The traditional model of healthcare delivery in the United States has been to provide sexual and reproductive health (SRH) care as a separate service in private settings, in clinics, such as Planned Parenthood, and in underfunded community health centers and public health departments (Auerbach et al., 2012). Deemed too fragmented, the more contemporary approach is to integrate SRH into primary care specialties. However, there is concern among women’s health leaders about the adequacy of SRH preparation for nurse practitioners (NPs) educated in primary care specialties, such as Family, Adult/Gerontology, and Pediatrics. This editorial highlights our concerns about SRH content for women and men in NP primary care curricula and outlines the steps that need to be taken to assure competency of primary care NPs to care for the SRH needs of the population. Previously thought of as maternal and child health care, contemporary opinion is that SRH should be available and accessible for all men and women, including ethnic and sexual minorities, throughout their life span (World Health Organization [WHO], 2009). This expanded view includes preconception care, sex education, contraception, pregnancy and unplanned pregnancy care, gynecological and other women’s health care, genitourinary conditions of men, infertility, sexual health promotion, and care coordination with public health and other primary care services (Auerbach et al., 2012). We support the WHO’s recommendation that SRH be integrated into existing primary care in ways that reduce barriers to access (WHO, 2011). This healthcare delivery model is utilized extensively and successfully in the United Kingdom (Royal College of Nursing, 2009). Of concern, however, is whether or not primary care education for NPs in the United States includes sufficient content to prepare these primary care providers to assume the full array of SRH care. Implementation of the Patient Protection and Affordable Care Act 2010 is predicted to strain healthcare delivery resources, in that persons currently without health insurance will have access to health insurance on healthcare exchanges and care may be provided through accountable care organizations. In addition, the total number of adults of reproductive age (18–44) in the United States is expected to increase from 112 million to 125 million by 2025. SRH services will surely need to increase proportionately. NPs are central to SRH care in this country; however, a number of workforce changes threaten the supply of NPs appropriately educated and trained to provide these services (Auerbach et al., 2012). For example, the RAND study (Auerbach et al., 2012) identified a reduction in programs that prepare Women’s Health NPs. Instead, the preponderance of programs prepares NPs in the primary care specialties already specified. Although recent forecasts by Auerbach et al. (2012) predict a large growth in the supply of NPs, most will be educated in primary care specialties. This then begs the question as to whether or not these NPs will be adequately prepared to meet the SRH needs of the burgeoning patient population. It is no longer feasible or desirable to provide SRH care in a fragmented fashion that necessitates women and men seeing multiple providers. With the projected growth in NPs educated in primary care, we need to redouble our efforts to insure they are adequately prepared to meet the increasing demands for SRH care in primary care settings. It has been well established there is a direct relationship between safe and quality care and a nurse’s education and training (Aiken, Clarke, Cheung, Sloane, & Silber, 2003). Further, the ever-changing evidencebased science and clinical understanding of SRH demands that we must be careful not to throw the baby out with the bath water. Hence, discontinuing Women’s Health NP programs and courses (Auerbach et al., 2012), and limiting SRH content to NP primary care focused curricula is certainly a serious concern. It is critical that nurses and particularly educators in NP primary care specialties carefully look at the following:

A Randomized Controlled Trial of the Effects of Mindfulness-Based Stress Reduction (MBSR[BC]) on Levels of Inflammatory Biomarkers Among Recovering Breast Cancer Survivors

Purpose: The purpose of this substudy of a large randomized controlled trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction (Breast Cancer) (MBSR[BC]) program compared to usual care (UC) in normalizing blood levels of pro-inflammatory cytokines among breast cancer survivors (BCS). Method: A total of 322 BCS were randomized to either a 6-week MBSR(BC) program or a UC. At baseline and 6 and 12 weeks, 10 ml of venous blood and demographic and clinical data were collected and/or updated. Plasma cytokines (interleukin [IL]-1β, IL-6, IL-10, tumor necrosis factor [TNF] α, transforming growth factor [TGF] β1, soluble tumor necrosis factor receptor [sTNFR] 1) were assayed. Linear mixed models were used to assess cytokine levels across three time points (baseline and 6 and 12 weeks) by group (MBSR[BC] vs. UC). Results: Of the six measured cytokines, three were nondetectable at rates greater than 50% (IL-10, IL-1β, TGF-β1) and, because of overall low prevalence, were not analyzed further. For the remaining cytokines (TNFα, IL-6, sTNFR1), results showed that TNFα and IL-6 increased during the follow-up period (between 6 and 12 weeks) rather than during the MBSR(BC) training period (between baseline and 6 weeks), while sTNFR1 levels did not change significantly across the 12-week period. Conclusions: Study results suggest that MBSR(BC) affects cytokine levels in BCS, mainly with increases in TNFα and IL-6. The data further suggest that B-cell modulation may be a part of immune recovery during breast cancer management and that increases in TNFα and IL-6 may be markers for MBSR(BC)-related recovery.

Allostatic perspectives in women veterans with a history of childhood sexual assault

Background: Women veterans have increased reports of sexual victimization compared to women in general, including childhood sexual assault (CSA) before military service, increasing the risk of military sexual trauma. Findings from recent studies reveal negative health effects following a history of CSA. There is a strong relationship between CSA and revictimization in civilian and military life, which may contribute to allostatic load. Objectives: (1) To determine the relationship between women veterans’ CSA history and later sexual assault history and (2) to determine the relationships between women veterans’ CSA and primary mediators and secondary and tertiary outcomes of allostasis. Research design: Cross-sectional. Subjects: Women (N = 81), 18–70 years old, veterans of the U.S. Armed Services. Measures: Participants completed questionnaires and blood and hair samples were collected. Several scales were utilized: Posttraumatic Checklist–Military, Center for Epidemiological Studies–Depression Scale, Pain Outcomes Questionnaire–Short Form, Cohen’s Perceived Stress Scale (PSS), Profile of Mood States, and an investigator-developed sexual harassment/assault instrument. Results: Thirty-three percent of participants reported CSA; of these, 38.5% reported military sexual assault and 70.3% sexual assault during civilian life. Those with CSA had higher cholesterol, triglycerides, perceived stress scores, and greater pain and fatigue than those without CSA. Hair cortisol was marginally lower in women with CSA when PSS was controlled, suggesting a dampened hypothalamic–pituitary–adrenal axis. Conclusions: These data suggest that some women veterans with a history of CSA may have increased allostatic load and be at increased risk for a variety of later life illnesses.