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Elevated homocysteine levels and low vitamin B12 and folate levels have been associated with deteriorated bone health. This systematic literature review with dose-response meta-analyses summarizes the available scientific evidence on associations of vitamin B12, folate, and homocysteine status with fractures and bone mineral density (BMD). Twenty-seven eligible cross-sectional (n = 14) and prospective (n = 13) observational studies and one RCT were identified. Meta-analysis on four prospective studies including 7475 people showed a modest decrease in fracture risk of 4% per 50 pmol/L increase in vitamin B12 levels, which was borderline significant (RR = 0.96, 95% CI = 0.92 to 1.00).Meta-analysis of eight studies including 11511 people showed an increased fracture risk of 4% per μmol/L increase in homocysteine concentration (RR = 1.04, 95% CI = 1.02 to 1.07). We could not draw a conclusion regarding folate levels and fracture risk, as too few studies investigated this association.Meta-analyses regarding vitamin B12, folate and homocysteine levels, and BMD were possible in female populations only and showed no associations. Results from studies regarding BMD that could not be included in the meta-analyses were not univocal. [ABSTRACT FROM AUTHOR]

Background: The urine protein:creatinine ratio (UPC) is used to quantify urine protein excretion and guide recommendations for monitoring and treatment of proteinuria., Hypothesis/objectives: Home urine samples will have lower UPCs than hospital samples. The objectives were to compare UPCs of samples collected in each setting and to determine whether environment of sample collection might affect staging, monitoring or treatment recommendations., Animals: Twenty-four client-owned dogs., Methods: Prospective, nonmasked study. Clients collected a urine sample from their dog at home and a second sample was collected at the hospital. Dogs receiving corticosteroids or angiotensin-converting enzyme inhibitors were excluded, as were those with urine samples of inadequate volume, no protein on dipstick analysis, or active urine sediment. Samples were refrigerated after collection, dipstick and sediment evaluations were completed and each sample was frozen at -80°C within 12 hours. UPCs were performed on frozen samples within 2 months., Results: From 81 paired samples, 57 were excluded. Of the remaining 24, 12/24 (50%) had higher hospital sample UPCs, 9/24 (38%) had identical UPCs, and 3/24 (12%) had lower hospital UPCs. The UPCs of hospital samples were higher than home samples for the total population (P = .005) and the subset with UPC > 0.5 (P = .001)., Conclusions: Setting and related circumstances of urine collection in dogs is associated with UPC differences; results are usually higher in hospital than in home samples. This difference has the potential to affect clinical interpretation., (© 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Unlabelled: AIM(S) OF THE PAPER: This paper critiques cultural education in nursing. Current approaches to cultural education, embedded in traditional anthropology, are obsolete and fail to acknowledge the global environment that impacts even the most remote and isolated cultures. The argument is made that new, transformative approaches to cultural education are needed., Background: Cultural awareness of the other is the foundation of existing strategies to teach cultural education. Students are encouraged to learn about each culture, often described as a monolith, by learning the unique characteristics of a group with a common race, ethnicity, or other distinguishing feature. Despite the increased emphasis on cultural education in nursing worldwide, culturally based problems persist. Nurse and health care researchers continue to report disparities in health, an unequal distribution of health care, and the lack of knowledge and sensitivity when caring for clients from another culture., Discussion: Globalization contributes to differences within cultures that may equal or exceed differences between cultures. Evidence is presented that current nursing education emphasizes cultural distinctions that do not persist in the postmodern world. Problems adherent to the continued use of cultural monoliths as the foundation of cultural education are discussed and expanded perspectives on culture and cultural education are presented., Conclusion: The principles of transformative education are offered as an alternative to the current approaches to cultural education. Students are encouraged to be vulnerable to personal change when interacting with people from other cultures because transformative education is as much about personal growth as it is about enhanced care of others. This modernized approach to cultural education transcends the standard adaptation of care from the dominant culture of the health care delivery system to the culture of the client/patient.

Purpose: To describe the Ethical Issues Scale (EIS), its conceptual development and psychometric evaluation, and its uses in determining how frequently nurses experience ethical issues in practice., Design: The EIS was validated with a sample (N = 2,090) of New England registered nurses (RNs) currently in practice. The sample was randomly split into two approximately equal samples. The calibration sample was used to derive the underlying components; the validation sample was used to confirm the component structure., Methods: Psychometric analysis of the 35-item EIS included: (a) item analysis, (b) confirmatory principal components analysis (PCA), and (c) internal consistency reliability using Cronbach's alpha., Results: Three components (end-of-life-treatment issues, patient care issues, and human rights issues) were demonstrated, confirming the original conceptually-derived structure. The calibration sample accounted for 42.4% of initially extracted common variance; the validation sample accounted for 41.5% of initially extracted common variance., Conclusions: The three EIS subscales had satisfactory internal consistency reliability and factorial validity for use as independent scales in future studies.

In infusion nursing practice, outcomes research involves identifying and measuring outcomes sensitive to, and most consistent with, current infusion nursing practice and theory. This article discusses what outcomes should be measured in infusion nursing; how to frame the study problem, develop a working research question, and define study variables; and how to design the method for sampling, variable measurement, data collection, and proposed data analysis. The article concludes with a discussion of how to apply research components using retrospective descriptive-comparative and prospective experimental approaches, and details how to write up the final research report.

The purpose of this paper was to describe the process of developing an instrument for measuring the compliance of adolescents with a chronic disease. The aim was to develop an instrument that could be used in a clinical setting to evaluate the compliance of young people with a chronic disease and to test a theoretical model of compliance, which had been developed along with the instrument. The instrument was originally developed to measure the compliance of adolescents with diabetes and later adjusted to measure the compliance of adolescents with asthma, rheumatoid arthritis and epilepsy. To test and develop the instrument, face and criterion validity, factor analyses, linear structural relations (LISREL) analyses, correlation coefficients and Cronbach's alpha were used. The instrument has 13 background questions and 41 items to measure compliance and factors connected to it.

Compliance has been studied from a wide range of scientific perspectives including medicine, nursing, psychology and health economics. There is no agreement regarding a commonly accepted definition. Lack of consistency in the definition and measurement of compliance is a major problem in research which becomes more complicated in an international study. The response to the confusion over the term compliance has been to suggest and use alternative terms such as adherence, co-operation, mutuality and therapeutic alliance. These terms are ill-defined and often are used as synonyms. The purpose of this paper is to analyse definitions of the concept of compliance. Abstracts from MEDLINE have been analysed in order to identify the types of compliance research that have been carried out.

Educational exchange programs have a long academic history. Through such programs, students expand their knowledge of cultures in their home country and the larger world. Typically, students learn about a particular substantive area, such as politics, economics, health care, or language. There is also a loftier goal: to encourage understanding and respect for the people of other countries and share experiences with family and friends at home. In a biography of William J. Fulbright, the developer of the preeminent exchange program that bears his name, the senator is described as hoping that in a democratic country like the United States, "the knowledge and understanding of other cultures would inevitably trickle down through the educational system to those who were not privileged to travel abroad" (1, p. 131).

This exploratory study of family nursing practice in public health care was conducted in Finland and Utah. Staff nurses were interviewed in focus groups and asked to describe their practice of family nursing, the factors promoting and restraining practice, and the impact of the changes in health care delivery on practice. Thirty-six Finnish and 30 Utah nurses participated. Pressure to do more activities with fewer nurses and resources, changes in family problems, and skill level of the nurses were common themes. However, differences were evident. Finnish public health nurses used emotional support and information to help families empower themselves to use resources and to strengthen their family unit. Utah nurses focused first on individual level goals and then family cohesion and health. Nurse-initiated referrals and direct physical care were the primary intervention strategies of Utah nurses. Unlike the U.S. health care system, access for all in maternal and child health care and school health allowed Finnish nurses to develop long-term relationships with families, thus advancing family nursing practice. This study identifies several potential variables for further study particularly related to the organization of health care and nurse-family relationships.

Clients' adaptation is frequently studied in nursing and used to guide nursing practice. Many nurse authors have suggested that adaptation may be a unique conceptual framework for nursing. Other nurse authors have suggested, however, that in focusing on adaptation, nursing limits its focus to changing clients to fit the environment and neglects to change the social system or environment to meet clients' needs. The purpose of this article is to argue that adaptation theory limits the range of clients' acceptable responses to change. Adaptation theory assumes clients are responsible for adjusting to the norms or standards established by a relatively immutable environment. An alternate set of assumptions broadens the range of acceptable responses by clients and targets the environment for change. On the basis of these assumptions, directives are given for nursing research aimed at studying clients' responses to change.

This study based on the revised Pender Health Promotion Model (HPM) was conducted to determine the extent to which selected demographic modifying factors, health locus of control, self-efficacy, and current health status explained engaging in six health promotion practices in a sample of 397 employed Mexican American women aged 19 to 70 years who lived and worked in the Rio Grande Valley of Texas. Self-administered test packets contained measures of demographic characteristics, health locus of control, self-efficacy, health status, and the six health promotion practices. Canonical correlational analysis demonstrated two significant canonical variate pairs explaining 88% of variance in the dependent set, the subscale mean scores of the Health-Promoting Lifestyle Profile. Age; education; self-efficacy; internal and powerful others health locus of control; and prior, current, and future health status made statistically significant contributions. However, the demographic variables made only a minimal contribution, confirming the recent conclusions of researchers that the HPM as currently configured provides an inadequate explanation of the modifying factors' role in health promotion activity. Study results make an important addition to the understanding of how lifestyle factors contribute to Mexican American women's health and well-being.

The purposes of this study were to describe the health-promoting lifestyle behaviors of 397 employed Mexican American women and to compare them with women in other published reports that used the Health-Promoting Lifestyle Profile (HPLP). Mexican American women had the highest HPLP total scores of all minority groups, but lower scores than all predominantly White groups. HPLP self-actualization and interpersonal support were the highest subscale scores. The exercise subscale was the lowest score for all groups, including minorities. Canonical analysis revealed two significant canonical variate pairs explaining 88% of variance. Age, education, self-efficacy, health locus of control (internal and powerful others), and current health status made statistically significant contributions to all HPLP subscale scores. Study results support previous research findings and make an important contribution to understanding the factors that influence Mexican American women's health-promoting lifestyle behaviors.

The Theory of Transcending Options was developed in a grounded theory study of the health behaviors of female single parents. The 2-year study reported in this article is the first statistical test of the associations between the independent variables identified in the theory and the number of health behaviors practiced by divorced women with children. Data on demographics, psychological variables, and social support were collected from 148 women at three points in time over 2 years. These data were entered into three stepwise multiple regression analyses, with health behaviors as the dependent variable. Each analysis was statistically significant. The independent variables that made statistically significant contributions to health behavior practices in one or more of the regression analyses were education, number of years single, depression level, self-esteem, and total social support. The results of this study indicate that further clarification and testing of the theory are warranted.

Nursing in the next century will reflect changes in the health care system, and although the profession has made great strides in preparing nurse researchers, the current system has a serious gap that must be addressed; that of preparing clinical leaders. The article describes the need for a practice-focused doctoral curriculum that will produce a new type of senior clinician or expert practitioner to fill this gap. The envisioned graduates will be skilled in clinical decision making and information processing and will effect changes at both the micro- and macro-levels of the system. There is a clear future need to expand the number of primary care providers. The faculty required for their education must be doctorally prepared nurses who are themselves clinically proficient. The research and practice doctorates should be differentiated by faculty, the program of studies, resources, and placement/expectation of graduates. The article includes a model curriculum plan.

A study of the support networks and social support of recently divorced women with children was conducted over two years. Its purpose was to assess changes in the women's social support and identify their unmet needs. Data were collected from 148 women by mailed questionnaire and telephone interview soon after the final divorce decree, and again at two years. The women did experience a significant decrease in network size and social support over two years; however, the primary members of their networks--family and friends--remained stable. Women with preschool-age children had more family support than those with older children. Nine categories of unmet needs were identified. Most frequently cited, in descending order, were emotional support, financial assistance, need for a boyfriend/partner/spouse, time for herself, and child care. The average number of needs per woman was less than two. The findings of this study confirm the losses in overall network size and support that women experience after divorce. The identification of unmet needs helps nurses to target areas in which women may require assistance to find social support.

The purpose of this study was to determine the degree to which selected components derived from Pender's Health Promotion Model (1982) explained engaging in health promotion practices in a sample of 477 persons 65 years and older. One directional hypothesis was tested using canonical correlation analysis. Three significant canonical variates were demonstrated, explaining 88.7 percent of variance. Older healthy persons with high self-esteem and internal locus of control reported practicing five of the six health promotion strategies. Men with higher income and self-esteem but poorer health less often exercised or ate well. Older married subjects with higher incomes who were internally controlled were more likely to engage in exercise, health responsibility and stress management but not in interpersonal support. Findings provide direct multivariate support for the additive nature of the relationships posited in the Health Promotion Model.

This article describes the development and psychometric evaluation of the Health-Related Hardiness Scale (HRHS). The HRHS was developed to measure the effects of hardiness in individuals with actual health problems. Items were generated that measured the presence, rather than absence, of the hardiness dimensions based on theoretical definitions of health-related control, commitment, and challenge. Two factors were isolated using principal components analysis (n = 389). These two factors, Challenge/Commitment and Control, accounted for 32.1% of variance. Factor loadings were strong, ranging from .41 to .68. Parsimony of the HRHS was achieved by reducing the original 51-item scale to 34 items. Alpha reliability coefficients were .91 for the total scale and .87 for each subscale. Test-retest, reliability coefficients ranged from .74 to .78. The final scale retained only two of the originally conceptualized three dimensions of the health-related hardiness construct.

This paper is a report of the synthesis of feminism and science in a study of the personal goals of recently divorced women with children. The divorce records of three counties were used to identify the participants; eight categories described the primary goals identified by 250 women. Independence, followed by employment and education were the most frequently cited categories. Analysis of variance was computed to analyze the relationships among the primary goal categories, the personal characteristics of the women and their feminist attitudes. Age was the only variable related to selection of a primary goal. Older women chose employment and environmental goals more often than they did mental health goals.

Social support is a combination of a person's perceptions of support, the belief that the support is personally satisfying, and the actual provision of services. Although the literature is replete with the work of researchers who have addressed the components of support, there is a notable limitation--the perspective of the providers of support. This perspective is important for clinicians who work with a person's natural support system to enhance its effectiveness. In this descriptive study, 252 people identified by recently divorced women with children as providing their most significant support were interviewed. The authors' purpose in conducting the study was to identify the underlying processes involved in social support based on interviews with the women's significant support people. In the qualitative portion of the study the data analysis yielded eleven processes: deliberating, withdrawing, continuing, understanding, availing, anchoring, distancing, protecting, nurturing, valuing, and intruding. Each of these processes is described in this paper.