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Objective: This longitudinal study examines reciprocal and dynamic relations among daily hassles, the mother-child relationship, and adolescent behavior problems and whether the relations differed by sociodemographic variables.Method: Three waves of data about adolescent daily hassles, quality of the mother-child relationship, and adolescent behavior problems were collected from 454 Arab Muslim adolescents and their immigrant mothers over a 3-year period. Cross-lagged structural equation modeling (SEM) was used to examine reciprocal relations among the study variables.Results: Relations between the mother-child relationship and adolescent behavior problems were reciprocal, with a poor mother-child relationship contributing to greater behavior problems and behavior problems contributing to a decline in the quality of the mother-child relationship. Relations involving daily hassles were unidirectional: A better mother-child relationship contributed to fewer daily hassles and behavior problems contributed to more daily hassles but daily hassles did not contribute to more behavior problems. Father's education was the only sociodemographic variable that was significant: Adolescents with more highly educated fathers had a better mother-child relationship and fewer behavioral problems.Conclusions: Findings suggest that Arab American Muslim adolescents with behavior problems are differentially exposed to daily hassles but daily hassles are not the best point of intervention. Bidirectional relations between the mother-child relationship and adolescent behavior problems suggest intervening to improve the mother-child relationship and manage symptoms of adolescent behavior problems. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

A sensitive, secure, and consistent relationship with their mother is critical for young children. There is a dearth of knowledge about the quality of mothering of young children by women with bipolar disorder. These mothers are frequently challenged, unable to provide consistency, and are at risk for loss of child custody. The model described in this article reflects a critical analysis of conceptual and empirical literature regarding mothering quality, resourcefulness, disorder severity, medication adherence, social supports, and child-rearing beliefs. The model can provide a conceptual framework for research, direct the selection of research instruments, and hypothesize the relationships among constructs. [ABSTRACT FROM AUTHOR]

The article focuses on a study which aims to identify distress-intensity cut-points of the Respiratory Distress Observation Scale, an innovative solution to assessment when a dyspnea report cannot be elicited. It notes that the Respiratory Distress Observation Scale has acceptable reliability and validity psychometrics, and signifies patient's need for palliation of respiratory distress. Conclusion of the study is offered.

The article presents an evaluation of the Bereaved Parent Needs Assessment (BPNA) as a tool to measure the needs of parents whose children died in the pediatric intensive care unit. The study tested the hypothesis that need fulfillment would be negatively related to complicated grief and positively related to quality of life during bereavement. Data suggest that the BPNA is a valid tool and that meeting parents' needs around the time of their child's death may promote adjustment to loss.

The article discusses a study that evaluated the Fall Risk Model for Injection Drug Users by assessing the association between injection drug use, chronic venous insufficiency and lower extremity impairment. The study examined the relationship between the Tinetti balance and gait total score and the role of injection drug use in fall risk. It was found that fall risk was associated with route of drug use.

-American Muslim adolescents in immigrant families face a number of challenges that put them at risk for behavior problems. This study of Arab-American Muslim Adolescents and their relatively recent immigrant mothers tested a longitudinal family-level model of adolescent behavior problems. Mother-adolescent dyads ( N = 530) completed measures of maternal and adolescent stressors, active and avoidance coping, and social support; maternal distress; quality of mother-child relationship; and adolescent behavior problems at Time 1 and approximately 18 months later. The youth were between the ages of 11 and 15 years at Time 1 and 48.7% were girls. Longitudinal analyses were conducted using latent change modeling with change scores from Time 1 and Time 2 data. Social support facilitated active coping for both mothers and adolescents. Although maternal avoidance coping mediated maternal stressors and its effect on maternal distress, maternal stressors and maternal distress were not related to adolescent behavior problems. The only factor mitigating the effects of adolescent stressors on adolescent behavior problems was the quality of the mother-child relationship. These findings suggest that adolescents are insulated from maternal stress and distress as long as there is a good mother-child relationship. [ABSTRACT FROM AUTHOR]

Injection users are at risk for vascular injuries resulting in chronic venous disease (CVD). The authors examined walking mobility in relation to CVD for 713 individuals in methadone treatment. The authors used a cross-sectional, comparative design that was stratified on age, sex, ethnicity, and drug use. CVD was present in 92.3% of participants. The structural equation model supported the causal link between leg injection and CVD (.40, P<.001). The worse the mobility, the greater was the CVD classification (-.21, P<.001). CVD had an indirect effect on mobility through pain. CVD and pain need to be considered when assessing mobility in illicit drug users. [ABSTRACT FROM AUTHOR]

We examined chronic venous disorders (CVD) in persons who injected illicit drugs. The study design was cross-sectional, comparative stratified by age, gender, ethnicity, as well as by three types of drug use (noninjection; arm or upper body injection only; and legs with or without upper body injection). Subjects completed demographic, health, and substances abuse questionnaires and were evaluated using the clinical component of the Clinical-Etiology-Anatomy-Pathophysiology Classification. Seven hundred and thirteen participants were evaluated. Those who injected in the legs ± arms had significantly worse CVD. Thirty-nine percent of leg ± arm injectors vs. 4.2% or noninjectors or arm only injectors had moderate to severe CVD. Persons who injected in the legs ± arms were 9.14 times more likely to develop venous ulcers than those that injected in the arms and upper body only and 34.64 times more likely as those who never injected. CVD was associated with injecting in the groin, legs and feet as compared with other sites. The pattern of disorders associated with leg injection is consistent with the underlying pathology of chronic venous insufficiency. [ABSTRACT FROM AUTHOR]

Background: Water-pipe smoking is a rapidly growing form of tobacco use worldwide. Building on an earlier report of experimentation with cigarette and water-pipe smoking in a U.S. community sample of Arab-American youth aged 14–18 years, this article examines water-pipe smoking in more detail (e.g., smoking history, belief in harmfulness compared to cigarettes, family members in home who smoke water pipes) and compares the water-pipe–smoking behaviors of Arab-American youth with non–Arab-American youth in the same community. Methods: A convenience sample of 1872 Arab-American and non–Arab-American high school students from the Midwest completed a 24-item tobacco survey. Data were collected in 2004–2005 and analyzed in 2007–2008. Results: Arab-American youth reported lower percentages of ever cigarette smoking (20% vs 39%); current cigarette smoking (7% vs 22%); and regular cigarette smoking (3% vs 15%) than non–Arab-American youth. In contrast, Arab-American youth reported significantly higher percentages of ever water-pipe smoking (38% vs 21%) and current water-pipe smoking (17% vs 11%) than non–Arab-American youth. Seventy-seven percent perceived water-pipe smoking to be as harmful as or more harmful than cigarette smoking. Logistic regression showed that youth were 11.0 times more likely to be currently smoking cigarettes if they currently smoked water pipes. Youth were also 11.0 times more likely to be current water-pipe smokers if they currently smoked cigarettes. If one or more family members smoked water pipes in the home, youth were 6.3 times more likely to be current water-pipe smokers. The effects of ethnicity were reduced as a result of the explanatory value of family smoking. Conclusions: Further research is needed to determine the percentages, patterns, and health risks of water-pipe smoking and its relationship to cigarette smoking among all youth. Additionally, youth tobacco prevention/cessation programs need to focus attention on water-pipe smoking in order to further dispel the myth that water-pipe smoking is a safe alternative to cigarette smoking. [Copyright &y& Elsevier]

Purpose: To identify potential confounders and test a causal model of injection-site risk, chronic venous disorders (CVD), and ankle mobility. The reliability and validity of goniometry measurements of ankle mobility were also of interest because they are seldom performed in people with a history of injection-drug use. Design: The study was a test-retest design, consisting of 104 participants from a methadone maintenance treatment center. Methods: Each participant provided demographic information, health and drug histories, and underwent bilateral ankle goniometric measures of dorsiflexion, plantar flexion, inversion, and eversion. The clinical portion of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP)was used to classify CVD severity. Findings: Reliability of goniometry measurements ranged from .70 to .90. Causal modeling supported hypotheses of increased risk from leg injection and reciprocal effects involving ankle mobility and disease progression. Ankle inversion mobility was the strongest indicator of ankle mobility. Conclusions: Injury to the lower extremities from IDU affected CVD and mobility. Further research should include assessment of comorbidity and other potential confounders. Ankle inversion should remain part of the goniometry assessment. [ABSTRACT FROM AUTHOR]

Between 1993 and 2002, 39 clinical trial staff were investigated for scientific misconduct by the Office of Research Integrity (ORI). Analysis of ORI case records reveals practices regarding workload, training and supervision that enable misconduct. Considering the potential effects on human subjects protection, quality and reliability of data, and the trustworthiness of the clinical research enterprise, regulations or guidance on use of clinical trial staff ought to be available. Current ORI regulations do not hold investigators or institutions responsible for supervision and training of clinical trial staff. Given the important issues at stake, the definition of research misconduct should encompass the intentional or negligent mismanagement of scientific projects. Individual institutions and professional associations not only can but should adopt stricter standards of conduct than those reflected in federal regulations. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to identify lifestyle and psychosocial factors associated with maintenance of normal body mass index (BMI, 18.5–24.9 kg/m2). Undergraduate students (n = 2781; 7.1% response rate) at a Big Ten university responded to a survey in 2018. BMI was calculated from the reported weight and height at the time of the survey and upon entering the university. Logistic regression analyses examined lifestyle and psychosocial health factors associated with maintenance of normal BMI by academic year. Results: Current BMI was within normal range for 68.8% of freshmen and 60.6% of seniors. Never consuming fast food was a significant predictor for maintaining normal BMI in sophomores (OR 3.78; 95% CI 1.61, 8.88; p < 0.01) and juniors (OR 7.82; 95% CI 2.14, 28.65; p < 0.01). In seniors, better psychosocial health (OR 1.40; 95% CI 1.12, 1.76; p < 0.01) was the only significant predictor for maintaining one's normal freshman BMI category. Among those within the normal BMI range upon entering the university, psychosocial health (OR 1.31; 95% CI 1.10, 1.55; p < 0.01) was the only predictor of retaining one's absolute BMI within ± 3% as a senior. Prospective studies are needed to better understand the interaction between environment, behavior, and psychological health involved in retaining normal weight. [ABSTRACT FROM AUTHOR]

Objective: This study tested a model of cancer‐related pain and functional status in African American patients, including beliefs about the ability to control pain as a key determinant of distress and functional status. Methods: Baseline data from a randomised clinical trial consisting of clinical and patient‐reported outcomes were used. Participants were 228 African American patients experiencing moderate to severe pain within the past 2 weeks. The model comprised four latent constructs: pain, perceived control over pain, pain‐related distress and functional status. Confirmatory factor analysis was used to validate the factor structure of the measurement model. Structural equation modelling was used to estimate direct and mediated effects. Results: The measurement model fit well (RMSEA = 0.06, SRMR = 0.05) with all loadings significant (p < 0.05). The structural model also fit well (RMSEA = 0.04, SRMR = 0.05). The complex mediated pathway from pain to functional status through perceived control over pain and pain‐related distress was strong and significant (specific indirect effect = −0.456, p = 0.004). Mediation by perceived control accounted for a 47% reduction of the effects of pain on functional status. Conclusion: If these results hold up longitudinally, interventions to increase perceived control over pain have the potential to improve functional status by decreasing pain‐related distress. [ABSTRACT FROM AUTHOR]

This paper describes the assessment of the psychometric properties of the Brief COPE in a sample of 189 pregnant African-American women. Confirmatory factor analysis (CFA) tested the original 14-factor model, and exploratory structural equation modeling (ESEM) determined whether a reduced number of factors still accounted for inter-item covariances. The CFA replicated 13 of the 14 original factors. After deleting substance use items and allowing for correlated error across the support factors, the 13-factor model achieved an acceptable fit (CMIN/ df = 1.77; RMSEA = 0.06, 95% CI = 0.05–0.07). ESEM resulted in three second-order factors: disengaged, active, and social support coping. Factor items were summed to create subscales with good internal consistency reliability (α =.74–.89). Social support coping and active coping were strongly correlated and accounted for nearly the same variance in four different psychological/affect scales, while disengaged coping was clearly distinct. [ABSTRACT FROM AUTHOR]

Pregnant African American women who report higher levels of social disorder (e.g., vacant housing, drug dealing) in their neighborhoods also report higher levels of depressive symptoms. The effects of social disorder in the neighborhood during childhood on depressive symptoms during pregnancy are not known. Also unknown is the interaction between social disorders in the neighborhood during childhood and during pregnancy regarding depressive symptoms during pregnancy. The purpose of this study was to examine whether higher levels of social disorder in the neighborhood during pregnancy buffered the association of social disorder in the neighborhood during childhood (at age 10 as reference) with depressive symptoms during pregnancy among African American women. We conducted a secondary data analysis of 1383 African American women from the Life-course Influences on Fetal Environments (LIFE) Study (Detroit, Michigan, 2009-2011). Women were interviewed in the hospital 24-72 h after the births. The Center for Epidemiological Studies-Depression (CES-D) scale measured depressive symptoms. Scales measuring social disorder in the neighborhood both during childhood and during pregnancy were also included in the interviews. Women with CES-D scores ≥ 16 were younger, were more likely to be single, and had lower levels of education and household income compared with women with CES-D < 16. There was a significant association between women who report social disorder in their neighborhoods during childhood and depressive symptoms during pregnancy. This effect was moderated by measures of social disorder in the neighborhood during pregnancy (p = .037). Women who reported both low levels of social disorder in their neighborhoods during childhood and during pregnancy had the lowest CES-D scores after controlling for maternal age, marital status, years of education, and family income. The model had a good fit to the data (χ2(6) = 6.36, p = .38). Health care providers should inquire about neighborhood conditions during childhood and during pregnancy and provide referrals for appropriate professional and community support for women who report social disorder in their neighborhoods and depressive symptoms. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a tool developed for palliative care at home called the Respiratory Distress Observation Scale (RDOS).

This study examined the occurrence of chronic venous disorders (CVD) and risk factors for its development in injection drug users. Injected drugs increase the risk of deep and superficial venous thrombosis and destroy veins from the trauma (i.e., repeated injection, irritating qualities of the abused drugs and substances, and localized infection). Venous damage can lead to CVD. Participants (N = 713) were 335 men (46.9%) and 378 women with M + SD age = 46.26 + 9.06 years. Four hundred forty (61.7%) were African American, 64.5% had a high school education or higher, and 30.0% were employed. The study design was cross-sectional. The sample was stratified on age, sex, ethnicity, and drug use (non—injection drug use, arm or upper body injection only, or legs + upper body). Instruments included demographic, health and substances abuse questionnaires, and the clinical leg assessment of the Clinical—Etiology—Anatomy—Pathophysiology (CEAP) classification. Participants were recruited from 12 methadone treatment clinics. Injecting in the groin, legs, and feet was associated with a significantly higher clinical CEAP classification than those who never injected or those who injected in the arms or upper body only F(2, 676) = 44.12, p < .001. Of the 10 specific venous disorders examined, 7 were significantly associated with leg injection. Three disorders, pigmentation, eczema, and lipodermatosclerosis, were most highly associated with active or healed ulcers. Years of injecting in veins of the legs were clearly nonlinear, monotonic, and decelerating, with the greatest increase in disease occurrence in the first 7 years. CVD is associated with injecting in the groin, legs and feet as compared to other sites. Protocols for leg assessment and methods to protect the legs need to be developed and tested with injection users. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) affect 22–75% of American young adults. ACEs are associated with adverse health outcomes that begin in young adulthood. Yet, scant research has examined if coping can mediate the relationship between ACEs and adverse outcomes. The current study determined if coping mediates the relationship between ACEs and body mass index (BMI), substance use, and mental health outcomes in young adults. A community sample of 100 White and 100 Black young adults 18–34 years of age participated in a cross-sectional study conducted via Zoom conferencing. Participants provided demographic data, height/weight, and completed measures of ACEs, coping, substance use, and mental health outcomes. Coping was measured using an established three-factor model consisting of adaptive, support, and disengaged coping. Structural equation modeling (SEM) examined the relationships of ACEs to outcomes as mediated by coping. Participants were predominantly female (n = 117; 58.5%) and mid-young adult (M = 25.5 years; SD = 4.1). SEM results indicated good model fit: (CMIN/df = 1.52, CFI = 0.94, RMSEA = 0.05 [90% CI = 0.03-0.07], SRMR = 0.06). Only disengaged coping mediated the ACE and substance use (β = 0.36, p =.008), smoking (β = 0.13, p =.004), and mental health (β=-0.26, p =.008) relationships. Disengaged coping styles may be a critical mechanism in developing adverse mental health and substance use outcomes among ACE-exposed individuals. Future ACE and health outcomes research should examine the role of coping. Interventions focusing on adaptive coping may improve the health of individuals exposed to ACEs. [ABSTRACT FROM AUTHOR]

Objective Prior research suggests that adverse neighborhood conditions are related to preterm birth. One potential pathway by which neighborhood conditions increase the risk for preterm birth is by increasing women's psychological distress. Our objective was to examine whether psychological distress mediated the relationship between neighborhood conditions and preterm birth. Design and Sample One hundred and one pregnant African-American women receiving prenatal care at a medical center in Chicago participated in this cross-sectional design study. Measures Women completed the self-report instruments about their perceived neighborhood conditions and psychological distress between 15-26 weeks gestation. Objective measures of the neighborhood were derived using geographic information systems ( GIS). Birth data were collected from medical records. Results Perceived adverse neighborhood conditions were related to psychological distress: perceived physical disorder ( r = .26, p = .01), perceived social disorder ( r = .21, p = .03), and perceived crime ( r = .30, p = .01). Objective neighborhood conditions were not related to psychological distress. Psychological distress mediated the effects of perceived neighborhood conditions on preterm birth. Conclusions Psychological distress in the second trimester mediated the effects of perceived, but not objective, neighborhood conditions on preterm birth. If these results are replicable in studies with larger sample sizes, intervention strategies could be implemented at the individual level to reduce psychological distress and improve women's ability to cope with adverse neighborhood conditions. [ABSTRACT FROM AUTHOR]

Background Symptoms of depression have been related to lower gestational age and preterm birth (<37 completed weeks gestation). Leisure time physical activity may have protective effects on preterm birth; however, less has been published with regard to other domains of physical activity such as walking for a purpose (e.g., for transportation) or the pathways by which symptoms of depression impact gestational age at birth. Methods This was a secondary analysis of available data of African American women. Women were interviewed within 3 days after birth. We proposed a model in which walking for a purpose during pregnancy mediated the effects of symptoms of depression (measured by the 20-item Center for Epidemiologic Studies-Depression [CES-D] scale) on gestational age at birth in a sample of 1,382 African American women. Results Using structural equation modeling, we found that the direct effect of CES-D scores of 23 or greater, which have been correlated with major depression diagnosis, on gestational age at birth was -4.23 ( p < .001). These results indicate that symptoms of depression were associated with a decrease in gestational age at birth of 4.23 days. Walking for a purpose mediated the effect of CES-D scores of 23 or greater on gestational age at birth. Conclusions Compared with African American women without symptoms of depression, African American women who had symptoms of depression walked less for a purpose during their pregnancy and delivered infants with lower gestational age at birth. If not medically contraindicated, clinicians should incorporate walking as part of prenatal care recommendations and reassure women about safety of walking during pregnancy. [ABSTRACT FROM AUTHOR]

Background Although depressive symptoms during pregnancy have been related to negative maternal and child health outcomes such as preterm birth, low birth weight infants, postpartum depression, and maladaptive mother–infant interactions, studies on the impact of neighborhood environment on depressive symptoms in pregnant women are limited. Pregnant women residing in disadvantaged neighborhoods reported higher levels of depressive symptoms and lower levels of social support. No researchers have examined the relationship between neighborhood environment and avoidance coping in pregnant women. Guided by the Ecological model and Lazarus and Folkman's transactional model of stress and coping, we examined whether social support and avoidance coping mediated associations between the neighborhood environment and depressive symptoms in pregnant African-American women. Methods Pregnant African-American women ( n = 95) from a medical center in Chicago completed the instruments twice during pregnancy between 15 and 25 weeks and between 25 and 37 weeks. The self-administered instruments measured perceived neighborhood environment, social support, avoidance coping, and depressive symptoms using items from existing scales. Objective measures of the neighborhood environment were derived using geographic information systems. Findings Perceived neighborhood environment, social support, avoidance coping, and depressive symptoms were correlated significantly in the expected directions. Objective physical disorder and crime were negatively related to social support. Social support at time 1 (20 ± 2.6 weeks) mediated associations between the perceived neighborhood environment at time 1 and depressive symptoms at time 2 (29 ± 2.7 weeks). An increase in avoidance coping between times 1 and 2 also mediated the effects of perceived neighborhood environment at time 1 on depressive symptoms at time 2. Conclusion Pregnant African-American women's negative perceptions of their neighborhoods in the second trimester were related to higher levels of depressive symptoms in the third trimester. If these results are replicable in prospective studies with larger sample sizes, intervention strategies could be implemented at the individual level to support pregnant women in their ability to cope with adverse neighborhood conditions and ultimately improve their mental health. [ABSTRACT FROM AUTHOR]

Abstract: We present a methodology to statistically discriminate among univariate and multivariate indices to improve accuracy in differentiating schizophrenia patients from healthy controls. Electroencephalogram data from 71 subjects (37 controls/34 patients) were analyzed. Data included P300 event-related response amplitudes and latencies as well as amplitudes and sensory gating indices derived from the P50, N100, and P200 auditory-evoked responses resulting in 20 indices analyzed. Receiver operator characteristic (ROC) curve analyses identified significant univariate indices; these underwent principal component analysis (PCA). Logistic regression of PCA components created a multivariate composite used in the final ROC. Eleven univariate ROCs were significant with area under the curve (AUC) >0.50. PCA of these indices resulted in a three-factor solution accounting for 76.96% of the variance. The first factor was defined primarily by P200 and P300 amplitudes, the second by P50 ratio and difference scores, and the third by P300 latency. ROC analysis using the logistic regression composite resulted in an AUC of 0.793 (0.06), p<0.001 (CI=0.685–0.901). A composite score of 0.456 had a sensitivity of 0.829 (correctly identifying schizophrenia patients) and a specificity of 0.703 (correctly identifying healthy controls). Results demonstrated the usefulness of combined statistical techniques in creating a multivariate composite that improves diagnostic accuracy. [Copyright &y& Elsevier]

Abstract: We examined the mother–child adjustment and child behavior problems in Arab Muslim immigrant families residing in the U.S.A. The sample of 635 mother–child dyads was comprised of mothers who emigrated from 1989 or later and had at least one early adolescent child between the ages of 11 and 15 years old who was also willing to participate. Arabic speaking research assistants collected the data from the mothers and children using established measures of maternal and child stressors, coping, and social support; maternal distress; parent–child relationship; and child behavior problems. A structural equation model (SEM) was specified a priori with 17 predicted pathways. With a few exceptions, the final SEM model was highly consistent with the proposed model and had a good fit to the data. The model accounted for 67% of the variance in child behavior problems. Child stressors, mother–child relationship, and maternal stressors were the causal variables that contributed the most to child behavior problems. The model also accounted for 27% of the variance in mother–child relationship. Child active coping, child gender, mother''s education, and maternal distress were all predictive of the mother–child relationship. Mother–child relationship also mediated the effects of maternal distress and child active coping on child behavior problems. These findings indicate that immigrant mothers contribute greatly to adolescent adjustment, both as a source of risk and protection. These findings also suggest that intervening with immigrant mothers to reduce their stress and strengthening the parent–child relationship are two important areas for promoting adolescent adjustment. [Copyright &y& Elsevier]

Research on forgiveness on the interpersonal level has found evidence of its positive health and mental health effects. However, there is no research on the health and mental health benefits of forgiveness in political conflicts. The removal of the dictator and the war in Iraq has provided researchers with opportunities to answer some questions about the effects of forgiveness in political conflicts. This study used a modified measure of forgiveness and measures of posttraumatic stress disorder (PTSD), cumulative trauma disorder (complex PTSD), health, and religiosity with a sample of 501 Iraqi refugees in Wayne County, Michigan. Results indicated that forgiveness of the collaborators has some positive mental health benefits and is associated with religiosity, whereas not forgiving them has serious health and mental health consequences. However, counter to predictions, un-forgiveness of the dictator was found to be associated with positive health and mental health. Health mediated the effects of un-forgiveness on PTSD. The significance of these results to working with victims of political violence and reconciliation is discussed. [ABSTRACT FROM AUTHOR]

Chronic venous insufficiency is a complex disease that can result in severe sequelae including venous ulceration. Though the exact progression from chronic venous insufficiency to venous ulcer remains unclear, the high cost and burden of this disease on patients and society is quite clear. Sustained ambulatory venous pressures or venous hypertension plays an integral role in the development of venous ulceration and involves the failure of the calf muscle pump system. Standard of care involves compression therapy to assist the calf muscle pump. However, several cofactors may contribute to or exacerbate this disease and understanding their impact may provide insight into new treatment modalities. Nerve involvement, which may result in neuropathic pain and muscle dysfunction, alterations in mobility and a decrease in range of motion may lead to gait alterations all affecting calf muscle pump function. In this paper, we analyze these cofactors and discuss possible treatment options to target them. Physicians treating this disease should be aware of the numerous factors involved in its development. Exploring new treatment options may 1 day lessen the burden and suffering caused by venous insufficiency. [ABSTRACT FROM AUTHOR]

In this study we used structural equation analysis to examine the relationship between chronic illness and depression among urban women. The model included the number of chronic illnesses reported, the demands of illness, perceived social support, and salient demographic variables as predictors of depression. The number of chronic illnesses had no direct effect on depression but had a direct impact on the demands of illness which led to decreased social support and increased depression. Being married played a protective role by reducing depression both directly and indirectly through increased social support. Having children under 18 in the home increased depression by increasing the demands of illness. These results provide important information about women with chronic illness and their resultant risk of depression. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the efficacy of the Power Over Pain--Coaching (POP-C) intervention to improve functional status among African American outpatients with cancer pain. SAMPLE & SETTING: 310 African American patients were recruited from an urban comprehensive cancer center. The study took place in the patients' homes. METHODS & VARIABLES: A two-group randomized design with repeated measures was used. Data were analyzed with linear mixed effects regression analysis and structural equation change score models. Variables were pain, pain-related distress, functional status, perceived control over pain, and the following antecedents to control: medication management, pain advocacy, and living with pain. RESULTS: Functional status was improved in POP-C participants relative to control group participants (p < 0.05). Distress also was differentially decreased (p < 0.05). Pain intensity ratings decreased significantly in all patients (p < 0.05). The largest intervention effects were observed in the living with pain component. IMPLICATIONS FOR NURSING: Perceived control over pain was strongly related to functional status and is amenable to interventions using the POP-C intervention components described in this article. [ABSTRACT FROM AUTHOR]

Introduction. Belief in one's ability to control pain is a significant predictor of health outcomes and is related to improved functional status. The purpose of this study was to introduce a novel formulation of the construct, Perceived Control Over Pain and to test its effects on functional status. Methods. Participants (N=301) were primarily African American (92%); and were adults with low income attending a primary care clinic and reporting pain within the past 2 weeks. A cross-sectional design was used with confirmatory factor analysis and structural equation modeling. The Perceived Control Over Pain construct consisted of four measures--two specific measures of control over pain and two general measures of control over life events. Perceived Control Over Pain has not been defined in this way previously. Results. Mean worst pain scores for the past week were 8.4, where "0" (no pain) to "10" (pain as bad as you can imagine). The model demonstrated good construct validity for the components of pain, Perceived Control Over Pain and functional status. Mediation by Perceived Control Over Pain was partial but strong, accounting for a reduction of 29% in the effect of pain on functional status. Discussion. In minority populations with low income, factors such as perceived control over pain and its effect on the outcome of patient function need to be considered. Improving Perceived Control Over Pain has the potential for improving patients' feelings of life control and purpose or meaning in life, and psychological and physical functioning for adults living with pain. [ABSTRACT FROM AUTHOR]

Living in a lower-quality neighborhood is associated with higher levels of depressive symptoms in the general population as well as among pregnant and postpartum women. However, little is known of the important pathways by which this association occurs. We proposed a model in which perceived stress and social support mediated the effects of neighborhood quality on depressive symptoms during pregnancy (measured by the 20-item Center for Epidemiologic Studies-Depression, CES-D, scale) in a sample of 1383 African American women from the Detroit metropolitan area interviewed during their delivery hospitalization. Using structural equation modeling (SEM), we built a latent variable of neighborhood quality using 4 measures (neighborhood disorder, neighborhood safety/danger, walking environment, overall rating). We then tested two SEM mediation models. We found that lower neighborhood quality was associated with higher prevalence of depressive symptoms during pregnancy (standardized total effect = .16, p = .011). We found that perceived stress partially mediated the neighborhood quality association with depressive symptoms. Although the association of social support with depressive symptoms was negligible, social support mediated associations of neighborhood quality with perceived stress [standardized path coefficient = .38 (.02), p = .009]. Our results point to the need for public health, health care, as well as non-health related interventions (e.g. crime prevention programs) to decrease overall exposure to stressors, as well as stress levels of women living in poor quality neighborhoods. Interventions that increase the levels of social support of women during pregnancy are also needed for their potential to decrease stress and ultimately improve mental health at this important time in the life course. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the reliability and validity of the Bereaved Parent Needs Assessment, a new instrument to measure parents' needs and need fulfillment around the time of their child's death in the pediatric intensive care unit. We hypothesized that need fulfillment would be negatively related to complicated grief and positively related to quality of life during bereavement.Design: Cross-sectional survey.Setting: Five U.S. children's hospital pediatric intensive care units.Subjects: Parents (n = 121) bereaved in a pediatric intensive care unit 6 months earlier.Interventions: Surveys included the 68-item Bereaved Parent Needs Assessment, the Inventory of Complicated Grief, and the abbreviated version of the World Health Organization Quality of Life questionnaire. Each Bereaved Parent Needs Assessment item described a potential need and was rated on two scales: 1) a 5-point rating of importance (1 = not at all important, 5 = very important) and 2) a 5-point rating of fulfillment (1 = not at all met, 5 = completely met). Three composite scales were computed: 1) total importance (percentage of all needs rated ≥4 for importance), 2) total fulfillment (percentage of all needs rated ≥4 for fulfillment), and 3) percent fulfillment (percentage of important needs that were fulfilled). Internal consistency reliability was assessed by Cronbach's α and Spearman-Brown-corrected split-half reliability. Generalized estimating equations were used to test predictions between composite scales and the Inventory of Complicated Grief and World Health Organization Quality of Life questionnaire.Measurements and Main Results: Two items had mean importance ratings <3, and 55 had mean ratings >4. Reliability of composite scores ranged from 0.92 to 0.94. Total fulfillment was negatively correlated with Inventory of Complicated Grief (r = -.29; p < .01) and positively correlated with World Health Organization Quality of Life questionnaire (r = .21; p < .05). Percent fulfillment was also significantly correlated with both outcomes. Adjusting for parent's age, education, and loss of an only child, percent fulfillment remained significantly correlated with Inventory of Complicated Grief but not with World Health Organization Quality of Life questionnaire.Conclusions: The Bereaved Parent Needs Assessment demonstrated reliability and validity to assess the needs of parents bereaved in the pediatric intensive care unit. Meeting parents' needs around the time of their child's death may promote adjustment to loss. [ABSTRACT FROM AUTHOR]

Abstract: Depression and inflammation are associated with poorer birth outcomes. African-American women have higher levels of inflammatory biomarkers, more depressive symptoms, and a disparate burden of poorer birth outcomes, but the association between depressive symptoms and inflammation within this higher-risk group is unknown. We examined this association among African-American women in the second trimester of pregnancy and additionally tested whether body mass index (BMI) mediates or moderates this relationship. We recruited 187 women from the obstetrics clinics of a large urban health system. Depression symptoms were measured with the Center for Epidemiological Studies Depression (CES-D) scale and inflammatory biomarkers (high-sensitivity C-reactive protein [hs-CRP], interleukin [IL]-6, IL-10, IL-1β, and tumor necrosis factor-α [TNF-α]) with enzyme immunoassays. Multivariate regression models were fitted to determine the association between CES-D score and each inflammatory biomarker. CES-D was not associated with hs-CRP or TNF-α. CES-D was directly associated with IL-1β (P =0.03). BMI moderated the relationship between CES-D and IL-6 (P <0.01) and IL-10 (P =0.04); in leaner women, depressive symptoms were associated with higher IL-6 and IL-10 levels, whereas in heavier women, depressive symptoms were associated with lower IL-10 levels. BMI did not mediate the relationship between CES-D and inflammation. We conclude that depressive symptoms are associated with increased inflammation among pregnant African-American women. Future studies are needed to examine if depression, mediated through inflammation, increases the risk of adverse pregnancy outcomes in African-American women. [Copyright &y& Elsevier]

A letter to the editor is presented in response to the article "Injection drug users in the United States, 1979-2002: An aging population," by G. L. Armstrong in a 2007 issue.

Background: Water-pipe smoking is a rapidly growing form of tobacco use worldwide. Building on an earlier report of experimentation with cigarette and water-pipe smoking in a U.S. community sample of Arab-American youth aged 14-18 years, this article examines water-pipe smoking in more detail (e.g., smoking history, belief in harmfulness compared to cigarettes, family members in home who smoke water pipes) and compares the water-pipe-smoking behaviors of Arab-American youth with non-Arab-American youth in the same community.Methods: A convenience sample of 1872 Arab-American and non-Arab-American high school students from the Midwest completed a 24-item tobacco survey. Data were collected in 2004-2005 and analyzed in 2007-2008.Results: Arab-American youth reported lower percentages of ever cigarette smoking (20% vs 39%); current cigarette smoking (7% vs 22%); and regular cigarette smoking (3% vs 15%) than non-Arab-American youth. In contrast, Arab-American youth reported significantly higher percentages of ever water-pipe smoking (38% vs 21%) and current water-pipe smoking (17% vs 11%) than non-Arab-American youth. Seventy-seven percent perceived water-pipe smoking to be as harmful as or more harmful than cigarette smoking. Logistic regression showed that youth were 11.0 times more likely to be currently smoking cigarettes if they currently smoked water pipes. Youth were also 11.0 times more likely to be current water-pipe smokers if they currently smoked cigarettes. If one or more family members smoked water pipes in the home, youth were 6.3 times more likely to be current water-pipe smokers. The effects of ethnicity were reduced as a result of the explanatory value of family smoking.Conclusions: Further research is needed to determine the percentages, patterns, and health risks of water-pipe smoking and its relationship to cigarette smoking among all youth. Additionally, youth tobacco prevention/cessation programs need to focus attention on water-pipe smoking in order to further dispel the myth that water-pipe smoking is a safe alternative to cigarette smoking. [ABSTRACT FROM AUTHOR]