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ABSTRACT: BACKGROUND:: Overall perceived health (OPH) is a powerful and independent predictor of negative health outcomes and low health-related quality of life. Overall perceived health is conspicuously low in patients with heart failure (HF). OBJECTIVE:: The purpose of this study was to determine the key predictors of OPH in persons with HF and explore possible mediating relationships. METHODS:: This cross-sectional predictive correlational study was a secondary analysis of an existing data set. Individual characteristics, biophysiological variables, physical symptoms, psychological symptoms, and physical and social functioning were identified from the Wilson and Cleary Model and tested as predictors of OPH in a 5-step hierarchical regression analysis. RESULTS:: The sample (n = 265) was primarily male (64.2%) and white (61.9%), with a mean age of 62 years, and had at least a high school education and a household income enough or more than enough to meet needs. Most (69.1%) had systolic dysfunction, and 78.5% were New York Heart Association class III or IV. The final model containing 15 predictors explained 39.2% of the variance in OPH. Six variables were significant independent predictors of OPH: perceived sufficiency of income, social functioning, comorbid burden, symptom stability, race, and the interaction of gender and social functioning, the last indicating social functioning as a stronger predictor for men than for women. In a multiple mediation analysis, the effects of shortness of breath and fatigue on OPH were mediated by physical and social functioning. Gender moderated the effect of fatigue through social functioning. CONCLUSIONS:: These variables explained a significant portion of the variance in OPH and can be used to target individuals at risk for low OPH and to tailor interventions. If OPH is low, a focus on patient symptoms and ability to participate in life activities is appropriate, with particular attention to social functioning in men.
The Journal of cardiovascular nursing 04/2012; · 1.43 Impact Factor
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ABSTRACT: Research has been limited in circadian activity rhythms and their relationship with health status in early-stage breast cancer survivors. Maintaining strong circadian parameters may reduce symptoms and improve physical functioning and disease-free survival.
This is a descriptive, correlational, secondary analysis of data from a randomized controlled trial collected 1 year after the first chemotherapy treatment; n = 156 cases with 7 days of wrist actigraph data of six circadian activity rhythm parameters; measures of function, fatigue, sleep, and anxiety/depression; and demographic/medical data including body mass index (BMI).
In the total sample and three BMI categories, acrophase was the only circadian parameter that reached means established in healthy adults. In the total sample, phase-delayed acrophase was associated with higher depression (r = 0.180, p = 0.025) and lower morning energy (r = -0.194, p = 0.016) and trended for higher fatigue (r = 0.153, p = 0.057). Lower morning energy was also associated with a lower circadian quotient (r = 0.158, p = 0.05). As BMI increased, weaker circadian parameters were recorded consistently. When compared with women in normal BMI categories, obese women's amplitude and 24-h autocorrelation coefficient were significantly weaker (p = 0.011-0.015). In obese women, phase-delayed acrophase was correlated with higher fatigue and anxiety and with lower morning energy and physical functioning.
Amplitude and 24-h autocorrelation parameters were significantly weaker, and phase-delayed acrophase was linked to several more intense symptoms and lower physical functioning in obese women.
Clinicians need to target high-risk women with phase-delayed rhythms, higher symptoms, and lower physical functioning for intervention.
Journal of Cancer Survivorship 04/2012; 6(3):305-14. · 2.63 Impact Factor
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ABSTRACT: Breast cancer survivors receive routine medical follow-up but are screened less frequently to detect symptom severity and interference with function in daily life.
Among breast cancer survivors, we describe the usual and worst severity of 5 common symptoms and the extent to which these symptoms interfere with general activity and enjoyment of life, we determine the associations among symptoms and the interference items, and we explore associations of interference with function and the most prevalent symptoms.
The cross-sectional, descriptive 1-page Breast Cancer Survivor Symptom Survey was mailed to breast cancer survivors identified in a clinical database (ONCOBASE). In total, 184/457 (40.3%) surveys were returned and 162 (35.4%) were used. Participants recorded usual and worst severity of 5 symptoms (fatigue, disturbed sleep, pain, distress, and numbness/tingling) and symptom interference with general activity and enjoyment of life during the past 7 days.
Participants reported usual symptom severity as mild and highest for sleep disturbance, followed by fatigue, distress, numbness/tingling, and pain. Participants recorded worst sleep disturbance and fatigue as moderately severe. Higher pain and fatigue were associated with all other symptoms, whereas disturbed sleep and distress were related to all except numbness/tingling. All symptoms interfered with general activity and enjoyment of life. Pain and numbness/tingling were associated with lower function and disturbed sleep, and made a unique contribution to fatigue.
Limitations of the study include relatively low response and use of a modification of an established scale.
Symptoms often coexisted and contributed to interference with daily function. Pain was most consistently associated with interference with function and severity of other symptoms.
The journal of supportive oncology 01/2012; 10(3):112-8.
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ABSTRACT: Background. This study investigated the associations of fitness and fatness with metabolic syndrome in rural women, part of a recognized US health disparities group. Methods. Fitness, percentage body fat, BMI, and metabolic syndrome criteria were assessed at baseline in 289 rural women with prehypertension, ages 40-69, enrolled in a healthy eating and activity community-based clinical trial for reducing blood pressure. Results. Ninety (31%) women had metabolic syndrome, of which 70% were obese by BMI (≥30 kg/m(2)), 100% by percentage body fat (≥30%), and 100% by revised BMI standards (≥25 kg/m(2)) cited in current literature. Hierarchical logistic regression models, adjusted for age, income, and education, revealed that higher percentage body fat (P < 0.001) was associated with greater prevalence of metabolic syndrome. Alone, higher fitness lowered the odds of metabolic syndrome by 7% (P < 0.001), but it did not lower the odds significantly beyond the effects of body fat. When dichotomized into "fit" and "unfit" groups, women categorized as "fat" had lower odds of metabolic syndrome if they were "fit" by 75% and 59%, for percentage body fat and revised BMI, respectively. Conclusion. Among rural women with prehypertension, obesity and fitness were associated with metabolic syndrome. Obesity defined as ≥25 kg/m(2) produced results more consistent with percentage body fat as compared to the ≥30 kg/m(2) definition.
Journal of obesity 01/2012; 2012:618728.
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ABSTRACT: This study measured the impact of the Exercise Adherence Management Program (EAMP) provided to 20 patients with heart failure (HF) who participated in a combined resistance and aerobic exercise training program during two 12-week phases. The EAMP included strategies designed to support exercise self-efficacy and adherence. Results indicate that an improvement in exercise self-efficacy occurred during the study period, whereas exercise adherence declined during the unsupervised phase. The highest rated adherence strategy for helpfulness and self-efficacy was group sessions. The study supports the use of adherence strategies based on self-efficacy in exercise programs for patients with HF.
Applied nursing research: ANR 11/2011; 24(4):207-14. · 0.87 Impact Factor
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ABSTRACT: The overall purpose of this article was to describe the challenges and benefits of conducting breastfeeding intervention research with two Native American Tribal communities.
A focus group with an interpretive approach was used to collect data within this qualitative study as a means of incorporating a complex, holistic, subjective interpretation of the case managers' perceptions and experiences. In addition, researchers' field notes were used. Findings are discussed in relation to Rogers' Diffusion of Innovation Framework.
Themes that emerged during the focus group discussions were related to innovation, relative advantage, complexity, compatibility, trialability, and observability.
Conducting research in Native American Tribal communities was both enriching and challenging. The research protocol needs to be culturally appropriate, and complex components need to be videotaped for review on an ongoing basis. Time constraints of case managers need to be examined prior to development of the research protocol.
Breastfeeding Medicine 10/2011; 7(3):167-72. · 1.65 Impact Factor
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ABSTRACT: Weight loss is challenging and maintenance of weight loss is problematic among midlife and older rural women. Finding effective interventions using innovative delivery methods that can reach underserved and vulnerable populations of overweight and obese rural women is a public health challenge.
This Women Weigh-In for Wellness (The WWW study) randomized-controlled trial is designed to compare the effectiveness of theory-based behavior-change interventions using (1) website only, (2) website with peer-led support, or (3) website with professional email-counseling to facilitate initial weight loss (baseline to 6 months), guided continuing weight loss and maintenance (7-18 months) and self-directed weight maintenance (19-30 months) among rural women ages 45-69 with a BMI of 28-45. Recruitment efforts using local media will target 306 rural women who live within driving distance of a community college site where assessments will be conducted at baseline, 3, 6, 12, 18, 24 and 30 months by research nurses blinded to group assignments. Primary outcomes include changes in body weight, % weight loss, and eating and activity behavioral and biomarkers from baseline to each subsequent assessment. Secondary outcomes will be percentage of women achieving at least 5% and 10% weight loss without regain from baseline to 6, 18, and 30 months and achieving healthy eating and activity targets. Data analysis will use generalized estimating equations to analyze average change across groups and group differences in proportion of participants achieving target weight loss levels.
The Women Weigh-In for Wellness study compares innovative web-based alternatives for providing lifestyle behavior-change interventions for promoting weight loss and weight maintenance among rural women. If effective, such interventions would offer potential for reducing overweight and obesity among a vulnerable, hard-to-reach, population of rural women.
ClinicalTrials.gov: NCT01307644.
BMC Public Health 06/2011; 11:521. · 2.00 Impact Factor
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ABSTRACT: Cognitive impairment is a recognized consequence of heart failure; however, there are no neuropsychological batteries with documented psychometric data in the chronic heart failure population.
To document the psychometric properties of a brief neuropsychological battery in a chronic heart failure sample.
The Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test Part A and Part B, and letter fluency was administered to a sample of individuals with chronic heart failure.
Eighty individuals with stable heart failure participated in this study. Individuals with chronic heart failure scored significantly lower than expected age and education adjusted norms in the domains of attention (p < 0.001), memory (p < 0.001), language (p < 0.001), executive function (p < 0.001), and psychomotor speed (p = 0.02). Scores on the tests of memory and executive function correlated to functional status (r = 0.28, p = 0.02 and r = 0.29, p = 0.03, respectively). Acceptable convergent validity and test-retest reliability were documented for this battery.
The neuropsychological battery had adequate reliability and validity in individuals with chronic heart failure.
European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 04/2011; 11(2):223-30.
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ABSTRACT: Despite known gender differences in recovery, few studies have examined symptom management (SM) interventions or responses by gender after coronary artery bypass surgery (CABS).
The purpose of this subanalysis was to describe and evaluate differences in response by gender to an SM intervention on the presence and burden of symptoms, physical activity, and physical functioning in elderly CABS patients during the early discharge period (3 and 6 weeks after CABS, and 3 and 6 months after CABS).
The parent study whose data were analyzed to examine gender differences involved a two-group, randomized clinical trial design. The 6-week early recovery SM telehealth intervention was delivered by the Health Buddy. Measures included the Cardiac Symptom Survey, a Modified 7-Day Activity Interview, an RT3 accelerometer, an Activity Diary, and the Medical Outcomes Study Short Form 36. This study was not powered for a gender × group analysis, and we used descriptive statistics, χ(2) tests, t tests, and analysis of variance for statistical analyses.
Subjects (n = 232) included 192 men and 40 women, with a mean age of 71.2 SD, 7 years. The intervention group consisted of 86 men and 23 women, and the usual care (UC) group consisted of 106 men and 17 women. Data trends suggest that the SM intervention exerted greater impact on women than on men for symptoms such as fatigue, depression, sleep problems, and pain. Again, men exhibited higher levels of physical activity than did women. However, women in the SM group generally had higher scores than did women in the UC group.
Although the parent study found no effect of an early recovery SM intervention, this exploratory secondary analysis indicated that women in the intervention group demonstrated more improvement in measures of physical activity than did those in the UC group. Further study, using a larger sample, is necessary to test these preliminary results.
Heart & lung: the journal of critical care 04/2011; 40(5):429-39. · 1.04 Impact Factor
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ABSTRACT: This pilot study examined the impact of a hospital transition intervention for older adults (≥ 65 years of age) with heart failure (HF) to promote medication use self-management. Forty subjects, hospitalized with either primary or secondary HF, had a mean age of 76.9 ± 6.5 years; 65% were males. The majority of subjects (55%) had NYHA Class III HF. A prospective, repeated measures experimental design was used. Baseline and follow-up data (1- and 3-months after hospitalization) were obtained using the Medication Regimen Complexity Index, Brief Medication Questionnaire, Drug Regiment Unassisted Grading Scale, and Kansas City Cardiomyopathy Questionnaire. Using repeated measures analysis of covariance (ANCOVA), with baseline measures as covariates, the transition intervention group had higher levels of medication adherence (F(1,35) = 13.4, p < .001), self-efficacy for HF self-care (F(1,35) = 17.9, p < .001) and had significantly fewer HF related symptoms that impaired health related quality of life (F(1,35) = 9.1, p = .006).
Western Journal of Nursing Research 11/2010; 32(7):849-70. · 1.19 Impact Factor
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ABSTRACT: The first anniversary for older widows (n = 47) has been explored during Months 11, 12, and 13. Concurrent correlations show that optimism inversely correlates with psychological (intrusion and avoidance) stress as measured with the Impact of Event Scale (r = -.52 to -.66, p < .005) and positively correlates with well-being (physical: r = .36 to .46, p < .025; psychosocial: r = .58 to .72, p < .005; spiritual: r = .50 to .69, p < .005). Lagged correlation patterns suggest that higher levels of optimism at a given time are associated with higher life satisfaction and spiritual well-being at later times. Psychological stress is higher at Month 12 when compared to Month 13, t(43) = 2.54, p = .01, but not when compared to Month 11, t(43) = 1.49, p > .10. There are no significant differences in physiologic stress (salivary cortisol) or well-being during the first anniversary of spousal bereavement.
Western Journal of Nursing Research 12/2009; 31(8):1035-56. · 1.19 Impact Factor
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ABSTRACT: This secondary analysis was conducted to determine the relationship between test weights and days of breastfeeding. Test weights were performed with a scale (accurate to 2 grams) before and after feeding. Days of breastfeeding was measured by self-reporting. All test weights were interrelated and were associated with higher days of breastfeeding. Test weights at day 2 to 4 and at 2 weeks were not correlated significantly with either intention or self-efficacy at any time. However, 6-week test weights were correlated with intention at all 3 times, and self-efficacy at 6 weeks. Women with higher breastfeeding self-efficacy scores tended to report higher intention to breastfeed for 6 months.
Journal of Human Lactation 12/2009; 26(2):168-74. · 1.15 Impact Factor
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ABSTRACT: Plasma B-type natriuretic peptide (BNP) levels obtained at rest have been previously shown to be correlated with the global functional capacity measures of peak oxygen uptake (V(O(2peak))) and the minute ventilation/carbon dioxide (VE/V(O(2))) slope. The purpose of this study was to assess the relationship of the plasma BNP level to the rate-pressure product (RPP) as an indicator of central or cardiac work capacity.
Twenty-two subjects (12 men), mean age 57 +/- 12 years, diagnosed with heart failure (8 ischemic/14 nonischemic) were recruited. All subjects were stable on optimal medical therapy for at least 1 month. Blood samples for BNP level analysis were obtained at rest. Subjects underwent a symptom-limited treadmill exercise test using a ramping protocol while V(O(2)), heart rate (HR), and blood pressure (BP) were monitored. Correlation analyses were conducted to assess the relationship of BNP level to RPP level, V(O(2peak), VE/V(O(2)) slope, end-tidal CO(2) pressure (P(ET)CO(2)), and left ventricular ejection fraction (LVEF).
Resting BNP levels were significantly correlated with RPP levels (r = -0.69). The BNP level and the RPP level were correlated with V(O(2peak)) (r = -0.63 and r = 0.66, respectively) and VE/V(O(2)) slope (r = 0.53 and r = -0.54, respectively). The RPP level but not the BNP level was correlated with P(ET)CO(2) (r = 0.57). Neither BNP nor RPP levels were well correlated with LVEF (r = -0.26 and r = 0.14, respectively).
The results of this study suggest that resting plasma BNP level may be a useful clinical measure for evaluating both global functional capacity and myocardial specific work capacity in individuals with heart failure.
Journal of cardiopulmonary rehabilitation and prevention 07/2009; 29(5):310-3. · 1.69 Impact Factor
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ABSTRACT: The purpose of this study was to examine patterns of circadian activity rhythms and their relationship with fatigue, anxiety/depression, and demographic/medical variables in women receiving breast cancer adjuvant therapy treatments (Tx) at three times within a randomized clinical trial (RCT) designed to improve sleep and modify fatigue.
A RCT enrolled 219 women with stage I-IIIA breast cancer who were randomized 2 days prior to starting chemotherapy to a behavioral therapy sleep intervention or healthy eating control group. All cases with available data (n = 190) were included in a descriptive, correlational, repeated measures analysis. Activity data were collected continuously by wrist actigraphy for 7 days at three times: the start (Tx 1), continuation (Tx 3), and recovery (30 days after last Tx) of chemotherapy. Circadian activity rhythm parameters were generated using Action4 software (Ambulatory Monitoring, Inc.). Measures collected simultaneously included Piper Fatigue Scale, Hospital Anxiety and Depression Scale, and demographic/medical variables.
Circadian activity rhythm parameters at three times in both groups were disrupted compared to healthy adults, but similar to values of cancer patients. Significant changes in mesor, amplitude, peak activity, and 24 h autocorrelation values were found over time in both groups. The intervention group's amplitude and circadian quotient values were significantly more robust. More robust activity rhythms were associated with lower fatigue, depressive symptoms, body mass index, and higher performance status in both groups.
Disrupted patterns of circadian activity rhythms were prevalent and associated with distressing fatigue and depressive symptoms during chemotherapy and at recovery. The intervention resulted in more robust rhythms.
Supportive Care in Cancer 05/2009; 18(1):105-14. · 2.09 Impact Factor
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ABSTRACT: PURPOSES/OBJECTIVES: To identify the predictors of fatigue 30 days after completing adjuvant chemotherapy for breast cancer and whether differences are observed between a behavioral sleep intervention and a healthy-eating attention control group in predicting fatigue.
Descriptive, exploratory, secondary analysis of a randomized clinical trial.
Outpatient oncology patients in a midwestern U. S. city.
96 women, ages 29-83 years, 72% married, 95% white, diagnosed with stage I-IIIA breast cancer, receiving adjuvant anthracycline and taxane chemotherapy.
Participants were randomized to a behavioral sleep intervention group or an attention control group. Participants completed data collection prior to and during the peak and rebound days of the initial chemotherapy treatment cycle and after the last treatment.
Fatigue, circadian rhythms of activity, objective and subjective sleep-wake, and objective and subjective activity-rest.
Predictors of fatigue were less total sleep time prior to treatment, higher fatigue prior to treatment and at the peak, and less energy upon awakening on rebound days. In the control group, predictors of higher fatigue were higher fatigue prior to treatment, higher body mass index, higher number of positive lymph nodes, and less daytime dysfunction. For the intervention group, lower peak activity at the peak of initial treatment differentially predicted fatigue.
Results suggest the sleep intervention group participants who maintained activity balanced with sleep at the peak of the initial treatment benefited most from the intervention.
Nurses should screen for fatigue prior to initial chemotherapy treatment and at regular intervals, further assess for poor sleep in patients who report fatigue of 4 or higher (on a 0-10 scale), and use evidence-based guidelines to select appropriate interventions.
Oncology Nursing Forum 02/2009; 36(1):38-48. · 1.91 Impact Factor
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ABSTRACT: The purpose of this study was to explore the relationship of two modifiable factors (intention to breastfeed for 6 months and breastfeeding self-efficacy) with the duration of breastfeeding in primiparous women.
Analyzed by logistic regression in a single prediction model, stronger intention (odds ratio = 1.89) and higher levels of self-efficacy at 2 weeks postpartum (odds ratio = 1.04) were significantly (p < .05) associated with an increased probability of breastfeeding for 6 months.
The combined influence of higher intention and self-efficacy increased the likelihood of breastfeeding for the recommended 6 months. Interventions to reinforce both should be designed and evaluated.
Applied nursing research: ANR 09/2008; 21(3):123-30. · 0.87 Impact Factor
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ABSTRACT: Physiological benefits of exercise training for heart failure (HF) patients have been demonstrated, however little is known about the effects of training on the symptoms of fatigue and dyspnea.
The purpose of this study was to examine HF symptoms of fatigue and dyspnea in response to a 24-week exercise training intervention.
This pilot study was a randomized, two-group repeated measures design. Fifteen subjects in the intervention group completed a combination of aerobic and resistance training three times per week in a standard cardiac rehabilitation setting. The control group consisted of 6 subjects who were instructed not to begin any formal exercise program during the 24-week intervention.
Subjects (19 males and 2 females) had a mean age of 66.2+/-10.2 years and mean ejection fraction (EF) of 28.4+/-7.4%. Non-parametric Friedman Analysis of Variance by Ranks showed the exercise group significantly decreased sensory fatigue (Piper Fatigue Scale) over time (chi(2)=6.49, p=.04) while the control group did not change (chi(2)=0.93, p=.63). Dyspnea showed a non-significant decrease over time for the exercise group (chi(2)=4.16, p=.13) while the control group showed a decrease from baseline to 12 weeks but an increase to above baseline values by week 24 (chi(2)=0.18, p=.91).
These results provide support for the beneficial effects of exercise training on symptoms of fatigue and dyspnea in HF patients. Larger studies to evaluate symptom response to exercise are needed.
European Journal of Cardiovascular Nursing 07/2008; 7(2):127-32. · 1.71 Impact Factor
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ABSTRACT: The purpose of this study was to test the psychometric properties of a new measure, the Meaning in Heart Disease instrument (MHD), in persons who underwent percutaneous coronary intervention (PCI). Within 1 year of PCI, 232 persons completed the MHD and construct validity measures (SF-36v2, Hospital Anxiety and Depression Scale). Study aims were examined using reliability analysis, factor analysis, and correlations. After factor analysis, four scales reflecting the theoretical concepts central to the conceptual framework of the instrument emerged--Disrupted Meaning (alpha = .93), Refocusing Global Meaning (alpha = .92), Searching for Answers (alpha = .82), and Ignoring Heart Disease (alpha = .77). Convergent and divergent validity was supported, in part, for all scales. The MHD had strong support for its validity and will be useful in testing nursing interventions aimed at helping individuals integrate heart disease into the life experience.
Journal of Nursing Measurement 02/2007; 15(2):145-60.
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ABSTRACT: The preoperative status of coronary artery bypass graft (CABG) surgical patients is often evaluated as a means to assess operative risk for mortality and morbidity and to inform how preoperative status influences or predicts outcomes following CABG surgery. The purpose of this study was to examine the influence of coronary artery disease (CAD) risk factor burden on CABG patients' preoperative functioning (functional status and functional capacity). A convenience sample of 152 subjects, 65 years and older, who had been consecutively enrolled in a larger randomized clinical trial, was evaluated. The RISKO Heart Hazard Appraisal was used to quantify CAD risk factor burden of the subjects. There were significant differences by CAD risk factor burden group, with subjects in the highest CAD risk factor burden group having poorer general health functioning (F2,147=3.45; P<.05) and functional capacity (F2,147=5.43; P<.01). These findings elucidate the potential usefulness of evaluating CABG patients' preoperative CAD risk factor burden status.
Progress in Cardiovascular Nursing 02/2007; 22(2):81-7.
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ABSTRACT: This research examined the relationship of cognitive-perceptual determinants from the Health Promotion Model to physical activity and healthy eating at baseline of a clinical trial among rural women aged 50 to 69. Two multivariate regression analyses with canonical correlation (N = 179) each yielded one interpretable canonical variate that explained similar amounts of variance (21.7% and 22.5%) in sets of activity and eating variables. In both analyses, the determinants set is a linear combination of all four cognitive-perceptual constructs from the model (perceived self-efficacy, benefits, barriers, interpersonal influences). The activity behavior set included caloric expenditure, VO2max, and stretching and strengthening activity, whereas the eating behavior set included daily percentage of calories from fat and servings of fruits and vegetables, meat, and whole grains. As predicted by theory, greater self-efficacy, benefits and interpersonal support, and fewer barriers are associated with desirable healthy lifestyle behaviors.
Western Journal of Nursing Research 07/2006; 28(4):449-68; discussion 469-74. · 1.19 Impact Factor
