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Background: Knowledge of the diurnal cortisol response to acute stress in healthy individuals can help us better understand the physiological and health effects of chronic stress. Objective: To compare the diurnal patterns of cortisol secretion of 15 medical students 2 weeks before a major written examination (control phase) and 2 weeks later at the time of the examination (acute stress phase). Design: Interrupted time series within-subjects. Results: During the acute stress phase, less cortisol was secreted over the course of the day, as demonstrated by a more prolonged and steeper decline in cortisol levels. In addition, higher cortisol levels were present in the evening. Despite these changes in the usual diurnal pattern, overall exposure to cortisol remained the same for both phases. Conclusions: The results of this study suggest that specific adaptations to the diurnal pattern of cortisol are made in the face of acute stress, important information for understanding cortisol regulation in health and illness.

In comparison to conventional questionnaires, calendar interviews produce higher quality retrospective reports of factual information. This study sought to examine whether calendar interviews would also be advantageous in collecting retrospective reports of subjective assessment information. Respondents in a panel study were randomly assigned to either a calendar or conventional questionnaire method; both methods asked for retrospective reports on years in which disability was present and annual health status since young childhood. Panel data served as a source of validation for the retrospective reports. Both methods tended to underreport the number of years disabled and yielded mean levels of better annual health status in comparison to the panel reports. Calendar interviews demonstrated higher quality retrospective reports for disability in yielding a significantly stronger correlation in the frequency of years being disabled and in providing a greater number of years of higher annual correspondence with the panel data in comparison to the conventional questionnaire. Calendar interviews also demonstrated the ability to preserve the slope of change associated with aging as seen in the panel data, whereas the conventional questionnaire led to a significantly shallower slope of change. This latter finding could not be explained by the presence of an acquiescence bias.

Perceptions of work conditions have proven to be important to the well-being of workers. However, customer loyalty, employee retention, revenue, sales, and profit are essential to the success of any business. It is known that these outcomes are correlated with employee attitudes and perceptions of work conditions, but the research into direction of causality has been inconclusive. Using a massive longitudinal database that included 2,178 business units in 10 large organizations, we found evidence supporting the causal impact of employee perceptions on these bottom-line measures; reverse causality of bottom-line measures on employee perceptions existed but was weaker. Managerial actions and practices can impact employee work conditions and employee perceptions of these conditions, thereby improving key outcomes at the organizational level. Perceptions of specific work conditions that engage employees in their work provide practical guidance in how best to manage people to obtain desired results.

Background: The incidence of adenocarcinoma of the esophagus and lung has been rising in the USA along with a parallel rise in obesity. This study was conducted to investigate possible common risk factors for these two types of cancer. Methods: Retrospective chart review was done and electronic medical records (EMR) of patients with a diagnosis of esophageal and lung cancer for the last 20 years were reviewed and data analyses done. Results: Esophageal and lung adenocarcinoma patients shared some common risk factors such as higher body mass index (BMI), diabetes mellitus (DM), hypertension, hyperlipidemia and gastroesophageal reflux disease (GERD). Conclusions: This study shows that obesity, GERD and metabolic syndrome are common risk factors for adenocarcinoma of esophagus and lung. Obesity may be contributing to the increasing incidence of these two types of cancer.

Although group therapy is widely used for individuals with substance use disorders (SUDs), randomized clinical trials (RCTs) comparing the same treatment in a group versus individual format are rare. This paper presents the results of a RCT comparing guided self-change (GSC) treatment, a cognitive-behavioral motivational intervention, conducted in a group versus individual format with 212 alcohol abusers and 52 drug abusers who voluntarily sought outpatient treatment. Treatment outcomes demonstrated significant and large reductions in clients' alcohol and drug use during treatment and at the 12-month follow-up, with no significant differences between the group and individual therapy conditions. A therapist time ratio analysis found that it took 41.4% less therapist time to treat clients using the group versus the individual format. Participants' end-of-treatment group cohesion scores characterized the groups as having high engagement, low levels of interpersonal conflict, and low avoidance of group work, all desirable group characteristics. These findings suggest that the GSC treatment model was effectively integrated into a brief group treatment format. Health care cost containment compels further evaluations of the efficacy of group treatments for SUDs.

Purpose/objectives To examine the relationships among fatigue and physical and mental quality of life (QOL) and different adjuvant chemotherapy regimens in patients with stage I-IIIA breast cancer prior to, during, and after treatment. Design Longitudinal, descriptive design embedded in a randomized, clinical trial. Setting Outpatient oncology clinics in the midwestern United States. Sample 196 postoperative women, mean age of 52 years, receiving anthracycline-based chemotherapy regimens: dose-dense taxane, dose-standard taxane, or dose-standard without taxane. Methods The Piper Fatigue Scale and Medical Outcomes Study SF-36(R) (v.2) Survey were completed 48 hours prior to treatment 1, at treatments 4 and 8, and 30 days after the final treatment. Main research variables Fatigue, adjuvant chemotherapy regimen, and QOL. Findings Fatigue and mental QOL changed significantly over time for all regimens, but the patterns of change did not differ based on regimen. Physical QOL changed significantly over time for all regimens, and the pattern of change differed based on whether taxanes were received. Higher fatigue was correlated with lower physical and mental QOL prior to and 30 days after the final treatment, regardless of regimen. Conclusions Women who receive taxanes are at higher risk for lower physical QOL over time. Higher fatigue was associated with lower QOL regardless of the chemotherapy regimens. Implications for nursing Clinicians should screen patients for fatigue and assess for contributing factors at clinic visits. Methods to integrate evidence-based fatigue interventions into practice should be tested and outcomes evaluated.

Objectives To examine the patterns and differences among sleep and hot flashes based on menopausal status (pre, peri, or post) in breast cancer adjuvant chemotherapy patients before, during, and after treatment. Design Secondary analysis from a randomized clinical trial. Setting Outpatient clinics and participants' homes. Patients/Participants Two hundred nineteen (219) women; mean age of 52 years (29-79); postoperative, Stages I to IIIA breast cancer. Methods Participants were randomized to a behavioral sleep intervention or a healthy eating control group. Variables measured were menopausal status (self-report), subjective sleep (Pittsburgh Sleep Quality Index), objective sleep (actigraphy), perceived interruption of sleep by hot flashes (diary), and demographic/medical characteristics. Data reported were collected 48 hours before initial chemotherapy, at treatment 4, and 30 days after the last treatment. Analysis included descriptives and repeated measures mixed model analysis of variance. Results Objective sleep and the perceived interruption of sleep by hot flashes changed significantly over time. Sleep and hot flashes differed over time by menopausal status. Only hot flashes were significantly different by study group and by menopausal status over time. Conclusion Women's menopausal status when starting chemotherapy was associated with differing patterns of sleep and hot flashes over time.

The primary aim of this pilot study was to test the effects of public/community health nursing (P/CHN) home visitation and a mutual goal-setting intervention on the intensity of need for nursing care levels and health behavior of vulnerable primary care clients. A secondary aim was to describe the content of client health behavior improvement goals. Eighty clients, aged 19-93 years, judged by their primary care providers to have unmet health needs were referred for P/CHN services. A quasi-experimental design was used, with the intervention group receiving the mutual goal-setting intervention. Senior baccalaureate nursing students, guided by faculty case managers, provided home visitation nursing care and the mutual goal-setting intervention. No significant effects of mutual goal-setting were found, however the 10-week P/CHN home visitation intervention was found to have significant positive effects on intensity of need for nursing care levels and health behaviors. Also, preferred client health improvement goals for this population are described. Several implications for P/CHN practice and research are discussed.

Background: To determine whether sleep quality and fatigue associated with breast cancer adjuvant chemotherapy treatments can be improved with behavioral therapy (BT) [Individualized Sleep Promotion Plan (ISPP©)] including modified stimulus control, modified sleep restriction, relaxation therapy, and sleep hygiene. Methods: Randomized-controlled trial based on Piper Integrated Fatigue Model, 219 stages I–IIIA breast cancer patients. Prior to the initial chemotherapy treatment, BT participants developed an ISPP plan that was regularly reinforced and revised. Controls received healthy eating information and attention. Pittsburgh Sleep Quality Index (PSQI), daily diary, actigraph, and Piper Fatigue Scale (PFS) data were collected 2 days prior, during the 7 days after each treatment, and 30 days after the last treatment. Repeated measures analysis of variance was used. Results: Prior to chemotherapy, participants reported mild fatigue and fairly poor sleep quality. All variables changed over time. A group by time interaction was found for sleep quality (PSQI) improving in the BT group. Diary revealed group differences on number of awakenings, minutes awake after sleep onset, and sleep efficiency. Fatigue (PFS) was similar between groups. Conclusions: The BT group showed improved sleep quality over time and better sleep (diary). Perceptions of improved sleep quality over time are not consistently associated with diary or actigraph, or result in lower fatigue. Copyright © 2008 John Wiley & Sons, Ltd.

When assessing individuals with alcohol use disorders, measurement of drinking can be a resource intensive activity, particularly because many research studies report data for intervals ranging from 6 to 12 months prior to the interview. This study examined whether data from shorter assessment intervals is sufficiently representative of longer intervals to warrant the use of shorter intervals for clinical and research purposes. Participants were 825 problem drinkers (33.1% female) who were recruited through media advertisements to participate in a community-based mail intervention in Toronto, Canada. Participants' Timeline Followback (TLFB) reports of drinking were used to investigate the representativeness of different time windows for estimating annual drinking behavior. The findings suggest that for aggregated reports of drinking and with large sample (e.g., surveys), a 1-month window can be used to estimate annual consumption. For individual cases (e.g., clinical use) and smaller samples, a 3-month window is recommended. These results suggest that shorter time windows, which are more time and resource efficient, can be used with little to no loss in the accuracy of the data.

Objectives: The primary purpose of this study was to describe individuals' knowledge and beliefs about genetics and smoking. Secondary purposes were to describe (a) differences in knowledge and beliefs based on smoking status, gender, and education and (b) relationships among perceived genetic predisposition for smoking, background characteristics, and knowledge and beliefs about genetics and smoking. Because genetics influences smoking, genetic information will likely be used to individualize future cessation treatment. Design: Questionnaire data were collected about knowledge and beliefs about genetics and smoking, smoking history, and demographics from visitors and staff at a nursing care facility. Data were analyzed with bivariate statistics and logistic regression. Sample: Participants (N=92), ages 19–82, were classified by smoking status. Results: Participants had little knowledge about genetics and smoking or mechanisms of heredity. Most did not believe that genetics caused smoking or influenced cessation. Predictors of perceived genetic predisposition for smoking were smoking status (current/former smoker), education (

Six hundred and twenty-six participants from the Panel Study of Income Dynamics (PSID) were interviewed via telephone ret- rospectively about life course events by either computer-assisted (CATI) event history calendar (EHC) or standardized CATI conventional ques- tionnaire (CQ) methods, randomly assigned. Experimental retrospective reports, for a reference period up to 30 years, were validated against reports provided annually from the PSID core interviews. Data quality outcome measures included variables associated with marriage, cohab- itation, employment, unemployment, residential changes, and cigarette smoking. The EHC provided higher quality retrospective reports for co- habitation, employment, unemployment, and smoking histories; the CQ provided better data quality for marriage history, although what variable was being measured, instead of which method was being used, had the biggest impact on differences in data quality. Both EHC and CQ inter- views lasted on average around one hour, with the EHC interviews being on average 10 percent longer. Interviewers preferred the EHC interviews. In both EHC and CQ conditions, respondents generally enjoyed the in- terviews, and did not find questions difficult. The costs and benefits of

Technology has transformed our lifestyles in dramatic and significant ways, including new and less expensive options for recruiting study participants. This study examines cost and participant differences between two recruitment sources, Craigslist (CL), and print newspapers (PNs). This paper also reviewed and compared studies involving clinical trials published since 2010 that recruited participants using CL alone or in combination with other methods.Secondary data analyses from a parent study involving a randomized controlled trial of a mail-based intervention to promote self-change with problem drinkers.Significant differences were found between CL and PN participants on most demographic and pretreatment drinking variables. While all participants had AUDIT scores suggestive of an alcohol problem and reported drinking at high-risk levels, CL participants had less severe drinking problem histories, were considerably younger, and had a higher socioeconomic status than PN participants. The total advertising costs for the 65 CL ads ($275) were significantly less than the 69 PN ads ($33, 311). The recruiting cost per eligible participant was vastly less expensive using CL ($1.46) compared to print newspaper ads ($116.88).Using CL is a viable recruitment method for soliciting participants, particularly those that are younger, for alcohol intervention studies. It is also less expensive than newspaper ads. When CL participants were recruited, they reported being slightly more confident to change their drinking than PN participants. Limitations of using CL are discussed, including that some initial ad responders gave inconsistent answers to similar questions and a few tried to enter the study more than once.

A variety of heteroleptic complexes of the type [Sn(acac)2Cl2- n(L) n] [where L = {O(CH2)3N=C(Me)Ar} and {ON=C(R)Ar}; R = Me, H; Ar = 2–C5H4N, 2–C4H3O or 2–C4H3S; n = 1 or 2] have been synthesised in quantitative yields by the metathetical reaction of cis-[Sn(acac)2Cl2] with the sodium salt of the ligands in anhydrous methanol–benzene mixture. Corresponding bis(acetylacetonato)methyloximatotin(IV) complexes have also been prepared by a similar reaction of cis-[Sn(acac)2IMe] with the potassium salt of the oximes. Absence of any significant shift in the hetero-aryl ring carbon/proton resonances of all the derivatives of internally functionalised ligands indicates non-participation of the hetero-atom of the ring on coordination to the tin atom. Spectroscopic data suggest retention of the cis-octahedral configuation for all these derivatives. Hydrolysis of [Sn(acac)2{ON=C(Me)C4H3O}Cl], followed by sintering at 650°C yielded pure SnO2 microcrystals, which were characterised by XRD and SEM analyses.

Reactions of RSnCl3 (R = Et and nBu) with internally functionalized oximes in 1:1 and 1:2 stoichiometric ratios in anhydrous benzene afforded non-ionic fibrous complexes of the general formula RSnCl3 · nHONC(R?)Ar [R = Et and Bu; R? = H, Me n = 1 and 2 (1–8); R? = only Me (9–11); Ar = 2-NC5H4, 2-OC4H3. Except for 1:1 furyl derivative, the value of 119Sn chemical shifts for all these derivatives in the 119Sn NMR spectra suggests hexa-coordination around tin atom. The crystal and molecular structures of one of the adducts nBuSnCl3 · HONC(Me)Py-2 · C6H5Me (2.tol.) and of a trinuclear hydroxo bridged stannoxane {nBuSnCl2(ONC(Me)Py-2)OH}2SnnBuCl · 0.5 HONC(Me)Py-2 (12), obtained on hydrolysis of nBuSnCl3 · 2HONC(Me)Py-2 (6), revealed a distorted octahedral environment around tin with the participation of both nitrogen atoms (ring as well as oxime nitrogen atom of the same ligand moiety) in coordination. In compound (2.tol.), the existence of intramolecular hydrogen bonding between the hydroxyl proton of the ligand moiety and the chlorine atom stabilizes the geometry. Unique asymmetric Sn–O(H)–Sn and Sn–O–N–Sn bridges are present in compound (12), resulting in a linear trinuclear stannoxane framework.

Colorectal cancer in African Americans has an increased incidence and mortality relative to Whites. The mean age of CRC development in African Americans is younger than that of Whites. There is also evidence for a more proximal colonic distribution of cancers and adenomas in African Americans. African Americans are less likely to have undergone diagnostic testing and screening for colorectal cancer. Special efforts are needed to improve colorectal cancer screening participation rates in African Americans. Clinical gastroenterologists should play an active role in educating the public and primary care physicians about special issues surrounding colorectal cancer in African Americans. Community healthcare groups and gastrointestinal specialists should develop culturally sensitive health education programs for African Americans regarding colorectal cancer. The high incidence and younger age at presentation of colorectal cancer in African Americans warrant initiation of colorectal cancer screening at the age 45 yr rather than 50 yr.

Objective To examine the effect of an intimate partner violence (IPV) educational program on the attitudes of nurses toward victims. Design A quasi‐experimental study utilizing a pretest and posttest. Setting An urban health care system. Participants Fifty‐two inpatient nurses completed both the pretest and posttest. Intervention One‐hour and 3‐hour IPV educational programs. Main Outcome Measures Change in attitude was determined by scores from the Public Health Nurses' Response to Women Who Are Abused (PHNR), a standardized questionnaire that measures nurses' reactions to an IPV scenario. Parallel forms, each with a different scenario, were administered before and 2 months after the 1‐hour and 3‐hour educational sessions. Scores were analyzed using a repeated measures analysis of variance followed by multiple comparisons with Bonferroni adjustments. Results Nurses' PHNR scores increased significantly after attending the 1‐hour session if they had previous IVP education and after the 3‐hour session if they had no previous IVP education. Conclusion Educational offerings should be tailored for nurses. For nurses with previous IVP education, offer a 1‐hour update. For nurses with no previous IVP education, provide a 3‐hour educational session. Further study is needed to determine if change in nurses' attitudes translates into improved screening, identification, and intervention for IPV victims.

This article describes a statistical modeling study designed to improve targets of need for registered nurse (RN) workforce. The model is place-based and incorporates the concepts of clinical need and regional service utilization. A cross-sectional study was conducted in Nebraska (1993-1999), and the unit of study was the county (N = 66). A mixed-model approach was used, and five predictor variables (% age 20-44,% age 45-64,% age 65+,% White non-Hispanic, and area) were significantly (p < .001) associated with service demand. Coefficient estimates were applied to various population projection scenarios, and the model’s algorithm converted service demand into number of RNs needed to compare numbers of RNs employed with projected need. The implications for RN workforce policy and funding decisions—at both federal and state levels—are significant. Further research with a larger, multistate database will be conducted to refine the model and demonstrate generalizability.

The purpose of this study was twofold: (a) to cluster women who experienced childhood sexual abuse (CSA) according to their shared patterns of CSA characteristics and (b) to examine differences across clusters on measures of other childhood abuse and adult health. Seven CSA characteristic variables were used for cluster analysis. The seven-cluster solution that emerged ranged from a noncontact extrafamilial CSA cluster that occurred without force only once to the most severe clusters in which penetration by an intrafamilial or extrafamilial abuser occurred multiple times with force. Significant differences among clusters were found for childhood emotional abuse and physical abuse, adult physical and psychosocial symptomatology, and depression. There were no significant differences for health care utilization. The results promote further understanding of which victims of CSA are more likely to have experienced other forms of childhood abuse and which victims are more at risk for poor health in adulthood.

The purpose of this study was to examine the relationships of personal factors (age and gender), barriers (symptom distress and negative well-being), and facilitators (self-efficacy to exercise and positive well-being) with self-reported physical activity in cardiac patients. Sixty-four participants (50 men, 14 women) 6-12 months post-cardiac event participated in this study. We found that age and gender accounted for 14.7% of the variance, symptom distress and negative well-being accounted for an additional 21.6% of the variance, and self-efficacy accounted for the remaining 7.6% of the variance for a total of 44% of the variance in physical activity levels explained. These results suggest that personal factors and barriers are central variables, in addition to self-efficacy, in understanding the levels of physical activity achieved by patients after a cardiac event.

The purpose of this pilot study was to (a) determine the feasibility of providing a heart failure disease management program through an in-home telehealth communication device (Health Buddy) and (b) compare the effectiveness of the Health Buddy with traditional home management strategies (telephonic, home visit) in achieving selected patient outcomes (self-efficacy, functional status, depression, and health-related quality of life). Ninety participants completed the study through 2 months. Thirty percent of participants were either eliminated prior to or withdrawn after enrollment from the study based on Health Buddy issues. A mixed model ANOVA revealed those who received telephonic disease management experienced decreased confidence in their ability to manage their heart failure whereas all other groups experienced increased confidence. Further ANOVA analyses indicated improvement over time with no group differences for functional status, depression, or health-related quality of life. These findings suggest that delivering a disease management program through a telehealth communication device is feasible and may be as effective as traditional methods.

Background: Although the number of alcohol treatment efficacy trials has mushroomed, there is no consensus on how best to measure outcomes. To advance the goal of establishing cross-trial consistency in measuring outcomes in clinical efficacy studies, the National Institute on Alcohol Abuse and Alcoholism convened a panel of experts and charged them with exploring, debating, and, ultimately, selecting a sentinel or optimal outcome measure to be used in future alcohol treatment studies. The goal of this article, one in a series of several presented at the National Institute on Alcohol Abuse and Alcoholism conference, is to discuss (1) the rationale underlying selection of an optimal outcome measure, (2) the necessary characteristics of an optimal outcome measure, (3) the utility of selecting an optimal measure, and (4) which drinking assessment methods could be used to collect data to portray the optimal outcome measure. Methods: At a minimum, the criteria for an optimal measure include that it be psychometrically sound. In addition, it should have considerable currency in the field, thereby increasing its prospects for adoption. The measure should also be consistent with the concepts of greatest interest and relevance to the field (e.g., directly reflect the fundamental goal of alcohol treatment). In light of these highly desired features, percent of days heavy drinking was chosen at the conference as a practical and relevant measure of alcohol treatment outcome. Conclusions: Percent of days heavy drinking should be the optimal measure of alcohol treatment outcome. Currently, daily drinking estimation methods are the most useful for gathering data that can reflect the optimal measure. In addition, data gathered by daily drinking estimation methods can be used to study a variety of other outcome variables of interest to clinical researchers.

To evaluate the relationship between drinking pattern and alcohol dependence severity, 209 individuals voluntarily seeking treatment for alcohol problems were administered the Alcohol Dependence Scale (ADS), the Short Alcohol Dependence Data (SADD) questionnaire, and a 12-month Timeline Follow-Back (TLFB) drinking assessment as part of their pretreatment assessment. Based on their TLFB data, participants were divided into two groups: daily (DD, n=84) and nondaily (NDD, n=125) drinkers. The two groups were compared on several demographic and drinking variables. It was hypothesized that DD would have higher scores on measures of alcohol dependence than NDD. However, the reverse pattern was found. The NDD had significantly higher ADS scores than the DD. An analysis of ADS subscale scores indicated that the primary difference between the two groups was in the domain of loss of behavior control. It is suggested that NDD may perceive intoxication as more impairing, perhaps because they have acquired less tolerance than DD. These results suggest that treatment focused on restoring a sense of behavior control would be beneficial for NDD.

Nationally, only 11%-20% of cardiac patients, on average, enroll in cardiac rehabilitation programs after their cardiac events. The purpose of this study was to examine: (a) differences in functional health outcomes, clinical risk factor outcomes, and lifestyle behaviors between patients who participated in cardiac rehabilitation (CR) and those who did not during the first year after their cardiac event; and (b) to examine predictors of and reasons for CR participation and non-participation in a Midwestern, rural clinical population. Green's health education framework guided the study. A cross-sectional, comparative design was used to mail surveys to 538 cardiac patients who were hospitalized over a 1-year period at a regional medical center; 255 surveys were returned, and the final sample numbered 222. Of these, 154 (69%) attended CR. Compared to nonparticipants (n = 68), participants reported significantly higher levels of functioning on 7 of the 8 subscales of the Medical Outcome Study Short Form-36 (SF-36). In relation to clinical risk factor outcomes, participants had a significantly lower body mass index than nonparticipants. Patients who attended CR reported that they had switched to low-fat foods, started an exercise program, lost weight, lowered stress, lowered blood pressure, and reduced blood cholesterol at significantly higher rates than non-participants. Patients were more likely to participate in CR if their physician explained its benefits, if they were told about it during their hospitalization, and if they lived close to a CR program. Patients with coronary heart disease need to be referred to CR for improved physical and psychosocial functioning and successful risk factor modification.

To evaluate outcomes of an intervention designed to promote sleep and modify fatigue after adjuvant breast cancer chemotherapy.Prospective, repeated measures, quasi-experimental, feasibility study.Midwestern urban oncology clinics.21 female participants, ages 43-66 years (meanX = 55.3) with stage I or II breast cancer status post four cycles of doxorubicin chemotherapy. Eight had four additional cycles of paclitaxel, 10 also had radiation, and 18 took tamoxifen.each woman continued to revise her Individualized Sleep Promotion Plan (ISPP), developed during her first cycle of chemotherapy, that included sleep hygiene, relaxation therapy, stimulus control, and sleep restriction components. The daily diary, Pittsburgh Sleep Quality Index, wrist actigraph, and Piper Fatigue Scale were used for seven days 30, 60, and 90 days after the last chemotherapy treatment and one year after the first chemotherapy treatment.Adherence and sleep and wake, fatigue, and ISPP components.Adherence to the ISPP components remained high at all times (77%-88%) except for stimulus control (36%-56%). Sleep outcome means and the actigraph revealed that (a) sleep latency remained less than 30 minutes per night, (b) the time awake after sleep onset exceeded the desired less than 30 minutes per night, (c) sleep efficiency scores ranged from 82%-92%, (d) total rest time ranged from seven to eight hours per night, (e) feelings on arising ranged from 3.7-3.8 (on a 0-5 scale), (f) nighttime awakenings ranged from 10-11 per night, and (g) daytime naps ranged from 10-15 minutes in length. Fatigue remained low, from 2.9-3.5 on a 0-10 scale.Adherence rates remained high for most components. Sleep and wake patterns were within normal limits except for the number and duration of night awakenings. Fatigue remained low.Future testing using an experimental design will focus on increasing ISPP adherence and decreasing nighttime awakenings. Adopting behavioral techniques to promote sleep may result in improved sleep and lower fatigue after chemotherapy.

Background: By using a public health approach to the treatment of alcohol problems, this study analyzed the efficacy and cost analysis of two versions of a community-level mail intervention to promote self-change among alcohol abusers who had never sought help or treatment. Methods: A total of 825 participants who responded to media solicitations were randomly assigned to one of two interventions: (a) for bibliotherapy/drinking guidelines (n = 411), they were given two pamphlets with information about the effects of alcohol and guidelines for low-risk drinking and self-monitoring, and (b) for motivational enhancement/personalized feedback (n = 414), personalized advice/feedback was provided on the basis of the participants' assessment of their drinking and related behaviors. Results: Although both groups exhibited significant reductions in drinking from 1 year before to 1 year after intervention, there were no significant differences between the two interventions for any variable. This suggests that the materials. irrespective of whether they were personalized, facilitated the reduction of drinking. Cost analysis revealed that a brief mail intervention could reduce drinking at a very low cost per participant (US$46 to US$97). Conclusions: A brief community-level mail intervention for problem drinkers who had never sought treatment resulted in sizable reductions in alcohol use over the year after the intervention compared with the year before. Furthermore, many of those with poorer outcomes engaged in a natural stepped-care process by seeking help. These results, coupled with the low cost to deliver the intervention, suggest that public health campaigns could have a substantial effect on reducing alcohol problems and associated costs as well as getting some individuals into treatment. Such an approach would represent a shift from the alcohol field's long-standing clinical focus to a broader public health perspective.

The purpose of this study was to advance evidence-based family-focused community and public health nursing (C/PHN) practice by examining 2 important indicators of health need, family health problem labels, and intensity of need for care, and their relationship to each other. The Omaha System (OS; Martin & Scheet, 1992) was the framework used to classify the most common family health problems. Intensity of need for care was determined using the Community Health Intensity Rating Scale (CHIRS; Hays, Sather, & Peters, 1998). Secondary analysis of C/PHN clinical data was done using a descriptive correlational design (n = 205). An investigator scored the CHIRS and assigned OS family problems based on clinical record data. The mean number of family health problems per person was 4.40 (+/- 2.06). The mean CHIRS total score was 33.9 (+/- 6.34). The total number of OS problems was significantly correlated with CHIRS total scores (r = .586, p < .001). Family problem labels and intensity of need for care both provide essential information for health need determination in C/PHN practice.

OBJECTIVES The incidence of sporadic colorectal cancer (CRC) among individuals younger than 50 years of age and the incidence of proximal cancers has varied based on demographic factors in previous studies, and multisociety screening guidelines advise various modalities for average-risk individuals beginning at age 50. We studied the incidence and anatomic distribution of CRC in a population of military veterans to determine whether screening at a younger age is warranted. METHODS In a retrospective review of the electronic medical records of patients diagnosed as having CRC at the Dayton Veterans Affairs Medical Center between 2000 and 2010, a descriptive analysis of age at diagnosis, race, indication for colonoscopy, and anatomical distribution of the tumor was performed. RESULTS A total of 280 patients with CRC were identified, 272 of whom were histologically confirmed as having adenocarcinoma. The majority (98.6%) were men, with 25.6% of them African American. The mean age at diagnosis was 68.9 years (range 41-89 years), with 35% diagnosed in the eighth decade of life. Only 8 patients (2.9%) were younger than age 50. Most tumors (55%) were located distal to the splenic flexure, with synchronous lesions identified in seven patients. Screening colonoscopy identified only 18 (3.6%) cases. CONCLUSIONS Sporadic colorectal adenocarcinoma in patients younger than age 50 was identified in only 2.9% of all cases, whereas 42.5% of all cases were located proximal to the splenic flexure. This reinforces the American College of Gastroenterology guideline recommendation to initiate CRC screening in average-risk individuals at age 50. This study supports optical colonoscopy as the preferred screening modality.

Although many people recover from substance-use associated problems on their own, little is known about this phenomenon. The paper had two objectives: to use a new research method, computer-assisted content analysis, to understand alcohol and drug abusers' perceived reasons for self-change and to undertake a comparative evaluation across substances and cultures to validate previous findings about subjective appraisal processes. Three studies of natural recoveries of alcohol and drug abusers in two countries conducted tape-recorded interviews with 216 respondents. The taped responses were coded based on a content analytic dictionary approach using a computerized content analysis program. All three studies found several processes mediating the decision to change substance use. The computer content analysis confirmed a cognitive appraisal process regardless of the cultural setting or substance. The findings suggest that several procedures might have benefit in clinical interventions.

The purpose of our pilot study was to evaluate the effects of a companion animal (dog) on physiologic arousal and behavioral distress among children undergoing a dental procedure. A repeated measures experimental design was used to study 40 children between the ages of 7 and 11 years who were undergoing procedures in a pediatric dental clinic. Half the children had the dog present during the procedure and half did not. Data were obtained before, during, and after the procedure. Behavioral distress was measured using the Observational Scale of Behavioral Distress; procedures were videotaped. Physiologic arousal was measured using a YSI telethermometer taped to the child's index finger. Student's t-test and repeated measures analysis of variance were used to answer the research question. No significant differences in behavioral distress or physiologic arousal were found between experimental and control groups. Further analysis revealed that for children who initially verbalized distress on arrival at the clinic, the presence of the dog decreased physiologic arousal during the time the child was on the dental table waiting for the dentist to arrive. Further research should be conducted to verify the effect of a companion animal on initial stress experienced by children for whom the visit to the dentist is most stressful.

The purpose of this study was to determine the self-report pain rating scale(s) that can be used to quantify pain in elderly persons across cognitive functioning levels. Randomly selected elderly subjects (N = 100) completed the Short Portable Mental Status Questionnaire to categorize their level of cognitive impairment: intact (n = 36), mild (n = 9), moderate (n = 15), and severe (n = 40). Pain was measured with the Memorial Pain Assessment Card verbal subscale, FACES, COOP pain subscale, a numeric rating scale, and the Present Pain Intensity subscale of the McGill Pain Questionnaire. Receiver operator characteristic curves indicated that participants categorized with moderate to no cognitive impairment were able to complete 1 or more of the pain assessment tools. Of the severely impaired, 30% were able to complete 1 or more pain assessment tools. Intraclass correlations showed a high degree of consistency among all pairs of tools (intraclass correlation > 0.74). We conclude that most elderly, with normal to moderately impaired cognitive functioning, as well as some severely impaired elderly, are capable of using self-report tools to rate their pain.

Background: Many similarities have been noted between urges and desires to drink heavily and obsessive-compulsive disorders (OCD). Based on such similarities, Modell et al. (1992) developed the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd), a modified version of YBOCS, to assess obsessions and compulsions related to heavy drinking. Evaluation of the YBOCS-hd has been limited to more severely dependent alcohol abusers. Methods: The present study used a self-administered version of the YBOCS-hd to evaluate (1) the severity of drinking-related obsessive compulsive symptoms with mild to moderately dependent alcohol abusers (problem drinkers), and (2) whether end-of-treatment changes in YBOCS-hd scores would be related to within-treatment functioning. Results: Results indicated that problem drinkers have lower alcohol-related Obsessive and Compulsive subscale scores than did more severely dependent drinkers, but higher scores than did non-problem drinkers, supporting the construct validity of the YBOCS-hd. In addition, at the end of treatment, the YBOCS-hd scores of alcohol abusers who drank at low-risk levels during treatment were significantly lower than the scores of those who drank at high-risk levels. Lastly, exploratory factor analysis did not provide support for the two purported YBOCS-hd subscales (Obsessive, Compulsive). Instead, the analysis yielded a single general factor and a second factor that contained two questions measuring heavy drinking. Conclusions: Despite the fact that total YBOCS-hd scores covaried with drinking, neither the total YBOCS-hd pretreatment score nor the two subscale scores predicted functioning at the end of treatment. The present results call into question the utility of the YBOCS-hd, because a single item measuring the heaviness of drinking was as useful as the total YBOCS-hd and its two subscales in relating changes during treatment to end-of-treatment functioning for problem drinkers. However, although the YBOCS-hd does not predict changes in drinking, it may have value as an indirect measure of drinking in situations where direct measurement of alcohol consumption is undesirable (i.e., direct measurement might be reactive). Because the present findings are derived from problem drinkers, further research is needed to confirm the factor structure of the YBOCS-hd with clients who represent a broader range of alcohol problem severity.

Although most alcohol abusers are dependent on nicotine, studies of such individuals have been scarce. Consequently, little information is available for advising clients who wish to consider resolving both problems. Clients entering an outpatient alcohol treatment program who were also current smokers were asked about their temporal preferences for changing their alcohol and cigarette use. Over three-quarters of alcohol abusers who were also smokers when asked said they would be willing to consider stopping smoking during or after treatment for an alcohol problem. Individuals who were interested in quitting smoking cigarettes while in treatment for an alcohol problem were different from those who did not want to stop smoking, and such differences may influence their ability to successfully address both problems together. Compared to those who preferred to change their drinking first then address their smoking, those who said they would be willing to address both problems (i.e. smoking and drinking) together in treatment were not only considerably more likely to think that quitting smoking would affect quitting drinking, but also more likely to be planning to quit smoking in the next six months. These results suggest that some individuals whose alcohol problems are not severe and who also smoke cigarettes will be more receptive to a dual recovery approach than others. In the absence of research findings, health care practitioners who encounter individuals who drink heavily and smoke cigarettes should at a minimum explore the option of dual cessation with their clients. The clinical and research implications of the present results are discussed.

This study evaluated the utility of using liver function tests to identify low dependence outpatient "alcohol abusers" (N = 253) and for evaluating changes in their drinking over the course of treatment. Despite drinking at levels considered to pose a health risk (i.e., drinking on 72% of all days in the year prior to treatment and averaging 6.3 drinks per drinking day), nearly two-thirds had normal liver function tests at treatment entry. It is concluded that for problem drinkers the cost of using liver function tests outweighs the benefits.

Copyright: © 2015 Chen P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. *Corresponding author: Sangeeta Agrawal, Associate Professor of Medicine, Dept. of Internal Medicine, Division of Gastroenterology, Wright State University, Dayton VA Medical Center, USA, Tel: 937-268-6511, ext 2698; Fax: 937-262-2154; E-mail: Sangeeta.Agrawal@va.gov