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Kyoung Suk Lee,1 Terry A Lennie,2 Debra K Moser2 1Seoul National University, College of Nursing, The Research Institute of Nursing Science, Seoul, South Korea; 2University of Kentucky, College of Nursing, Lexington, KY, USACorrespondence: Kyoung Suk LeeSeoul National University, College of Nursing 103 Daehak-ro, Jongno-gu, Seoul 03080, South KoreaTel +82- 2-740-8829Fax +82- 2-766-1852Email kyounglee@snu.ac.krBackground: Prior studies of symptoms in heart failure (HF) were largely cross-sectional and symptoms were measured using retrospective recall. Because negative emotions influence information processing, retrospective symptom reports by patients with depressive symptoms and anxiety may be biased. The purpose of this study was to determine whether there are differences in patterns of symptom changes, measured prospectively, over 15 days by levels of depressive symptoms and anxiety.Methods: HF patients (N=52) rated daily symptom severity for shortness of breath (SOB), fatigue, sleep disturbance, and edema over 15 days on a 10-point visual analogue scale. Patients were grouped into higher vs lower levels of depressive symptoms and anxiety, respectively, based on median scores of Brief Symptom Inventory subscales. Latent growth curve modeling was used to examine whether patterns of symptom changes over 15 days differed in higher vs lower levels of depressive symptom and anxiety groups.Results: Those in the higher depressive symptom group had lower levels of baseline symptom severity in SOB (β: − 1.46), fatigue (β: − 1.71), sleep disturbance (β: − 1.78), and edema (β: − 1.97) than those in the lower depressive symptom group. However, there were no significant differences in rates of changes in the severity of any of the four symptoms between groups. Anxiety was not associated with baseline severity of symptoms or rates of changes in any of the four symptoms.Conclusion: Depressive symptoms, but not anxiety, were associated with daily symptom experience. HF patients with higher levels of depressive symptoms may perceive their symptom severity differently than patients with lower levels of depressive symptoms.Keywords: depressive symptoms, anxiety, heart failure, symptoms

Kyoung Suk Lee,1 Frances J Feltner,2 Alison L Bailey,3 Terry A Lennie,4 Misook L Chung,4 Brittany L Smalls,5 Donna L Schuman,6 Debra K Moser41College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, South Korea; 2University of Kentucky, Family and Community Medicine, Lexington, KY, USA; 3University of Tennessee COM Chattanooga, Erlanger Health System, Chattanooga, TN, USA; 4College of Nursing, University of Kentucky, Lexington, KY, USA; 5College of Medicine Center for Health Service Research, University of Kentucky, Lexington, KY, USA; 6University of Kentucky, College of Social Work, Lexington, KY, USABackgrounds: Perceptions of health are important to motivate people to change behaviors. Non-adherence to healthy behaviors that prevent cardiovascular disease may result from inadequate health perceptions. However, there are few studies investigating relationships between health perceptions and psychological states.Objective: To determine whether psychological states (ie, depressive symptoms and anxiety) are associated with the congruency between health perception and estimated risk for cardiovascular disease in adults with 2 or more cardiovascular disease risk factors.Methods: Community dwellers at risk for cardiovascular disease were asked to complete the Patient Health Questionnaire-9 and the anxiety subscale of the Brief Symptom Inventory to measure depressive symptoms and anxiety, respectively. Participants rated their perceived health from excellent to poor. The estimated cardiovascular disease risks were measured with the 10-year cardiovascular disease Framingham risk scores. Participants were grouped into three health perception groups based on congruency between levels of health perception and cardiovascular disease risk. Multivariate multinomial logistic regression was done to examine the association between psychological states and health perception groups.Results: Of 828 participants 54.7%, 12.0%, and 33.3% had congruent, pessimistically biased, and optimistically biased health perception, respectively. Depressive symptoms were significantly associated with pessimistic bias (adjusted odds ratio: 1.070, 95% confidence interval 1.010–1.133), but not anxiety. Optimistic bias was not associated with either depressive symptoms or anxiety.Conclusions: A mismatch between individual health perceptions and cardiovascular disease risks was associated with depressive symptoms. As health perception is affected by depressive symptoms, clinicians should assess depressive symptoms when exploring health perceptions and engaging individuals in decision-making about a healthy lifestyle.Keywords: emotion, perception, cardiovascular diseases, healthy lifestyle

Background: Medication nonadherence contributes to hospitalization and mortality, yet there have been few interventions tested that improve adherence and reduce hospitalization and mortality in heart failure (HF). Our objective was to determine whether an education intervention improved medication adherence and cardiac event-free survival.Methods and Results: A randomized controlled trial was conducted on 82 HF patients. The intervention was based on the theory of planned behavior (TPB) and included feedback of medication-taking behavior using the Medication Event Monitoring System (MEMS). Patients were assigned to one of three groups: 1) theory-based education plus MEMS feedback; 2) theory-based education only; or 3) usual care (control). Cardiac events were collected for 9 months. Patients in both intervention groups were more adherent over follow-up compared with the control group. In Cox regression, patients in either intervention group had a longer event-free survival compared with those in the control group before and after controlling age, marital status, financial status, ejection fraction, New York Heart Association functional class, angiotensin-converting enzyme inhibitor use, and presence or absence of a significant other during the intervention (P < .05).Conclusions: Use of an intervention based on the TPB improves medication adherence and outcomes in patients with HF and therefore offers promise as a clinically applicable intervention to help patients with HF to adhere to their prescribed regimen. [ABSTRACT FROM AUTHOR]

Background: Anxiety is common after acute myocardial infarction and increases the number of complications and the length of stay in the hospital. Anxiety-induced activation of the sympathetic nervous system is hypothesized to be an underlying cause of increased complication rates. Little is known about whether use of β-blockers eliminates the effects of anxiety on complication rate and length of stay. Objective: To compare number of complications and length of stay among nonanxious and anxious patients receiving β-blockers during hospitalization. Method: A total of 322 patients with acute myocardial infarction participated in this study within 48 hours of hospital admission. Patients completed the Brief Symptom Inventory to assess anxiety level. After discharge, medical records were reviewed to determine use of β-blockers, type and number of complications, and length of stay. Results: Most patients (96%) were treated with less than 200 mg daily of metoprolol. Anxious patients had more complications (mean [SD], 1.43 [0.15] vs 0.73 [.09], P ≤ .01) and longer stays (7.0 [0.49] vs 5.7 [0.36] days, P < .05) than did nonanxious patients. To test whether the dose of β-blocker made a difference, the interaction between daily dose and anxiety score was tested. No interaction was found between metoprolol dose and anxiety score, and no main effect was found for metoprolol dose. Conclusion: Anxious patients had more complications and longer stays than did nonanxious patients. The administration of metoprolol did not eliminate this relationship, perhaps because patients did not receive a sufficient dose of metoprolol to counter the effect of anxiety. [ABSTRACT FROM AUTHOR]

BACKGROUND: Millions of family members deliver informal care and support to patients with heart failure (HF). Caregivers of patients with HF experience depressive symptoms, but factors associated with depressive symptoms are unknown. The purposes of this study were (1) to examine differences between caregivers with and without depressive symptoms in patients' characteristics and caregivers' functional status, caregiving burden (time devoted to caregiving, difficulty of caregiving tasks, and overall perceived caregiving distress), and perceived control; and (2) to determine predictors of depressive symptoms of caregivers. METHOD: A total of 109 caregivers (mean age of 57 years; spousal caregiver, 79%) and patients with HF participated in this study. Depressive symptoms, perceived control, and functional status of both patients and caregivers were assessed using the Beck Depression Inventory II, the Control Attitudes Scale-Revised, and the Duke Activity Status Index, respectively. Caregivers' burden (time and difficulty of caregiving tasks and burden) were assessed using the Oberst Caregiving Burden Scale and the Zarit Burden Interview. RESULTS: The 27.5% of HF caregivers with depressive symptoms (Beck Depression Inventory II score > or =14) had poorer functional status, lower perceived control, and higher perceived caregiving distress; experienced more caregiving difficulty; and spent more time in caregiving tasks than did caregivers without depressive symptoms. Controlling for age and sex in a multiple regression, caregivers' own functional disability (standard beta [sbeta] = -.307, P < .001), perceived control (sbeta = -.304, P < .001), and caregiver burden (sbeta = .316, P = .002) explained 45% of the variance in caregivers' depressive symptoms. Patients' New York Heart Association class and functional status did not predict caregivers' depressive symptoms. CONCLUSION: Caregivers' poor functional status, overall perception of caregiving distress, and perceived control were associated with depressive symptoms. Depressed caregivers of patients with HF may benefit from interventions that improve caregivers' perceived control, address the caregiving burden, and improve or assist with caregivers' functional status. [ABSTRACT FROM AUTHOR]

BACKGROUND: Because patients with heart failure (HF) experience multiple symptoms simultaneously, it is necessary to explore symptom clusters rather than individual symptoms to determine their impact on outcomes. Given gender differences in symptom experience, examination of potential gender differences in clusters is reasonable. OBJECTIVE: The objective of the study was to compare symptom clusters between men and women with HF, differences in patient characteristics among symptom clusters, and the impact of symptom clusters on cardiac event-free survival. METHODS: A total of 331 patients with HF recruited from HF clinics were included (35% were female and 62% were of New York Heart Association classes III/IV). Cluster analysis was used to identify symptom clusters between men and women based on ratings of distress related to 7 symptoms. Analysis of variance or chi test was used to compare characteristics of patient groups that were divided by the median split of total distress scores of each cluster. Cox proportional hazards regression was used to determine whether total scores of symptom distress in symptom clusters predicted time to first cardiac event. RESULTS: Two identical symptom clusters were identified in men and women: a physical symptom cluster composed of dyspnea, fatigue/increased need to rest, fatigue/low energy, and sleep disturbances and an emotional/cognitive symptom cluster composed of worrying, feeling depressed, and cognitive problems. Patients with higher distress from the physical symptom cluster were primarily females and of New York Heart Association classes III and IV (P < .05). Patients with higher distress from the emotional/cognitive symptom cluster were younger than those with lower distress (P < .05). The total symptom distress score in the emotional/cognitive cluster, but not the physical cluster, was an independent predictor of cardiac event-free survival (hazard ratio, 1.18; 95% confidence interval, 1.03-1.37). CONCLUSION: Although distress for individual symptoms may differ between men and women, they both experienced identical symptom clusters. Only the emotional/cognitive cluster predicted a higher risk for a cardiac event. These results suggested that interventions should be developed that consider symptom clusters. Targeting patients who have high distress from emotional/cognitive symptoms may be particularly important as they may be most vulnerable for adverse outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Physical symptoms are likely to occur in clusters that may be associated with adverse outcome in patients with heart failure (HF). Despite the importance of early recognition of worsening symptoms in HF management, the impact of physical symptoms on adverse outcome has not been explored in the context of symptom clusters. PURPOSE: The purposes of this study were to explore which physical symptom clusters occur in HF patients and to determine the impact of symptom clusters on event-free survival. METHODS: A total of 421 patients (60% male; 62 [SD, 14] years; 72% New York Heart Association class II/III) completed the modified Memorial Symptom Assessment Scale-Heart Failure to measure physical symptoms during an index hospitalization in Seoul, Korea. Times to first event of cardiac rehospitalization and cardiac death were collected for 12 months after discharge and confirmed by review of hospital records. An agglomerative hierarchical clustering approach with Ward's method was used to identify symptom clusters. Hierarchical Cox hazard regression was used to determine the impact of symptom clusters on cardiac rehospitalization and cardiac mortality. RESULTS: Two distinct symptom clusters, the dyspneic and the weary symptom clusters, occurred in patients with HF. Shortness of breath, difficulty breathing when lying flat, and waking up breathless at night comprised the dyspneic symptom cluster. Lack of energy, lack of appetite, and difficulty sleeping comprised the weary symptom cluster. In hierarchical Cox hazard regression, elevated distress from the weary symptom cluster independently predicted cardiac rehospitalization (hazard ratio, 1.45; 95% confidence interval, 1.09-1.93), and increased distress from the dyspneic symptom cluster independently predicted cardiac mortality (hazard ratio, 2.00; 95% confidence interval, 1.16-3.34). CONCLUSION: The weary and the dyspneic symptom clusters predicted cardiac rehospitalization and cardiac mortality, respectively. Patient education for self-monitoring of symptoms should focus on symptom clusters rather than single symptom. [ABSTRACT FROM AUTHOR]

Depressive symptoms are the most common psychological complication among patients with ESRD. Although depressive symptoms are a risk factor for increased morbidity and mortality, little is known about the mechanisms responsible for this association. Two pathways are described. The biological pathway involves interrelationships among depressive symptoms, inflammation, malnutrition, and atheroscloersis. The behavioral pathway includes the effects of depressive symptoms on dietary adherence. Recommendations include attention to therapeutic interventions that would influence these pathways to improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Anxiety is not routinely assessed in patients hospitalized for acute myocardial infarction (AMI). Failure to identify and treat patients who are anxious after AMI makes them more vulnerable to the adverse effects of anxiety, including higher complication rates. The anxiety subscale of the Brief Symptom Inventory (BSI) is a simple, reliable measure of anxiety with minimal patient burden. However, there is limited evidence of reliability and validity of the BSI as a measure of anxiety in patients hospitalized for AMI. Objective: The aim of this study was to provide evidence for the reliability and validity of the BSI in hospitalized AMI patients. Method: A total of 536 patients admitted for AMI (62 +/- 14 years of age, 66% men, 85% white, 27% with previous myocardial infarction) completed the BSI and the state portion of the State Anxiety Inventory (SAI) within 72 hours of admission. Internal consistency reliability, criterion-related validity, and construct validity of the BSI were tested. Results: There was sufficient evidence of internal consistency (Cronbach [alpha] = .87), which supported the reliability of the BSI. There was evidence of criterion-related validity based on the Spearman [rho] correlation coefficient of 0.70 (P < .001) between BSI and SAI scores. Anxious patients had higher complication rates than did nonanxious patients (BSI, 1.31 +/- 0.13 vs 0.82 +/- 0.08, respectively, P < .001; SAI, 1.34 +/- 0.13 vs 0.80 +/- 0.07, respectively, P < .001), demonstrating adequate construct validity. In a logistic regression, BSI scores were independent predictors of in-hospital complications after controlling for sociodemographic and clinical variables, which further supported construct validity. Conclusion: These results provide support for the BSI as a reliable, valid instrument for measuring anxiety in patients hospitalized for AMI. [ABSTRACT FROM AUTHOR]

Background: Rehospitalization rates are higher in African American than Caucasian patients with heart failure (HF). The reasons for the disparity in outcomes between African Americans and Caucasians may relate to differences in medication adherence. To determine whether medication adherence is a mediator of the relationship between ethnicity and event-free survival in patients with HF.Methods and Results: Medication adherence was monitored longitudinally in 135 HF patients using the Medication Event Monitoring System. Events (emergency department visits for HF exacerbation, HF and cardiac rehospitalization, and all-cause mortality) were obtained by interview and hospital data base review. A series of regression models and survival analyses was conducted to determine whether medication adherence mediated the relationship between ethnicity and event-free survival. Event-free survival was significantly worse in African Americans than Caucasians. Ethnicity was a predictor of medication adherence (P=.011). African Americans were 2.57 times more likely to experience an event than Caucasians (P=.026). Ethnicity was not a predictor of event-free survival after entering medication adherence in the model (P=.06).Conclusions: Medication adherence was a mediator of the relationship between ethnicity and event-free survival in this sample. Interventions designed to reduce barriers to medication adherence may decrease the disparity in outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The purpose of this study was to explore patients' perception about how the foods they eat impact heart failure (HF) symptoms, their understanding of dietary recommendations received, and factors affecting their adherence to dietary recommendations that include recommendations to follow a low sodium diet and a low-fat diet. METHODS: Qualitative data were obtained from 20 patients using semi-structured interviews. RESULTS: The majority of patients believed that food intake could impact their health, but less than half thought sodium could affect HF symptoms. Eighty-five percent of patients received recommendations for a specific diet, but only 60% reported following them. Factors identified as affecting adherence included: a) knowledge, b) social pressure and encouragement from others, c) social situations, and d) food as a source of pleasure and enjoyment. CONCLUSION: Ability to follow dietary recommendations remains a problem for many patients. Patients identified several key factors that affected ability to follow dietary recommendations. Strategies that target these factors may promote patients' decision to follow dietary recommendations and enhance their ability to do so. [ABSTRACT FROM AUTHOR]

Aims. To examine the impact of depressive symptoms on rehospitalisation for heart failure exacerbation in patients with preserved systolic function. Background. Depressive symptoms associated with higher risk of rehospitalisation have been primarily demonstrated in heart failure patients with systolic dysfunction (ejection fraction <40%) and the factors influencing rehospitalisation of patients with preserved systolic function (ejection fraction >=40%) remain unclear. Design. A prospective, descriptive study design was used. Methods. The following baseline data were collected from 165 patients with preserved systolic function during an index hospitalisation for heart failure in South Korea: age, gender, body mass index, New York Heart Association functional class, the ratio of mitral velocity to early diastolic velocity of the mitral annulus, comorbidities, history of prior admission and depressive symptoms. Patients were followed monthly for six months after discharge to collect date on all rehospitalisation for heart failure exacerbation. Hierarchical Cox proportional hazards regression was used to identify independent predictors of rehospitalisation. Kaplan-Meier survival curves with log-rank test were used to determine differences in time to rehospitalisation according to severity of depressive symptoms. Results. Almost half of the patients (48%) had moderate to severe depressive symptoms. The ratio of mitral velocity to early diastolic velocity of the mitral annulus (hazard ratio = 1·06, 95% confidence interval = 1·02-1·10) and depressive symptoms (hazard ratio = 1·05, 95% confidence interval = 1·02-1·08) independently predicted rehospitalisation after controlling for other risk factors. Moderate and severe depressive symptoms were associated with both a higher rate and shorter time to rehospitalisation. Conclusions. Moderate to severe depressive symptoms predict early rehospitalisation for heart failure exacerbations in patients with preserved systolic function. Relevance to clinical practice. Nurses should assess for depressive symptoms in patients with heart failure and refer those with depressive symptoms for treatment to improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Medication adherence in heart failure (HF) is a crucial but poorly understood phenomenon. The purpose of this study was to explore factors contributing to medication adherence in patients with HF by using the World Health Organization's multidimensional adherence model.Methods and Results: Patients (N = 134) with HF (70% were male, aged 61 +/- 12 years, 61% with New York Heart Association III/IV) were studied to determine the predictors of medication adherence derived from the multidimensional adherence model. Medication adherence was measured objectively using the medication event monitoring system for 3 months. Three indicators of adherence were assessed by the medication event monitoring system: 1) dose-count, the percentage of prescribed doses taken; 2) dose-days, the percentage of days the correct number of doses were taken; and 3) dose-time, the percentage of doses that were taken on schedule. Barriers to medication adherence, ethnicity, and perceived social support predicted dose-count (P < .001). New York Heart Association functional class, barriers to medication adherence, financial status, and perceived social support predicted dose-day (P < .001). Barriers to medication adherence and financial status predicted dose-time (P = .005).Conclusion: A number of modifiable factors predicted medication adherence in patients with HF, providing specific targets for intervention. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Many factors may contribute to medication nonadherence in heart failure (HF), but no standard measure exists to evaluate factors associated with nonadherence. To fill this gap, we developed the Medication Adherence Scale (MAS) and tested its reliability and validity in patients with HF. METHOD: Questionnaire data were collected from 100 patients with HF at baseline using the MAS, and objective adherence data were collected for 3 consecutive months using the Medication Event Monitoring System. RESULTS: Principal component analysis yielded three factors that explained 63% of the variance in medication adherence: knowledge, attitudes, and barriers to medication adherence. Cronbach's alphas for these subscales ranged from .75 to .94, which supported their internal consistency. The Spearman rho correlation coefficients between the Medication Event Monitoring System and Knowledge, Attitudes, and Barriers scores were .25 to .31 (P < .05), demonstrating support for construct validity. CONCLUSION: These results support the reliability and validity of the MAS as a measure of knowledge, attitudes, and barriers of medication adherence. [ABSTRACT FROM AUTHOR]

The purposes of this article were to describe the state of science in nutrition self-care in heart failure and make recommendations for future research. Four areas of nutrition self-care were reviewed: sodium restriction recommendations, nutrition recommendations, body weight recommendations, and self-care strategies. A review of the available evidence demonstrated that the current state of knowledge in each of these 4 areas is insufficient for clinicians to provide evidence-based interventions to improve nutrition self-care. Subsequently, research priorities in each area were identified. Although there is a growing recognition of the important role that nutrition may play in heart failure outcomes, advancements in our knowledge base are needed before nutrition self-care can evolve into an essential component of heart failure self-care. [ABSTRACT FROM AUTHOR]

BACKGROUND: The purpose of this study was to explore factors influencing adherence to the prescribed medical regimen in patients with heart failure (HF). METHODS: A convenience sample of 7 women and 9 men with HF participated in in-depth interviews. The interviews were audio-taped, transcribed, and checked for accuracy. Content analysis strategies were used to analyze the data. RESULTS: The desire to be healthy was the primary motivator in the decision to take medications as prescribed. The process of making connections enhanced medication adherence. Participants connected knowledge of their illness and their symptoms with their medication's effectiveness in decreasing these symptoms. Connections to a health care provider and family enhanced treatment adherence. Participants relied on environmental cues as reminders to take their medications, resulting in a habit of daily medication use. CONCLUSIONS: Education that helps clients understand their illness, particular symptoms and how medications help them may be beneficial in promoting adherence. A positive working relationship with the health care provider may result in improved adherence. [ABSTRACT FROM AUTHOR]

BACKGROUND: Heart failure (HF) and heart failure exacerbations are associated with distressing physical signs and symptoms that include dyspnea, peripheral edema and weight gain. There are no prior investigations that describe the daily fluctuations of these. PURPOSE: The purpose of this investigation was to characterize daily dyspnea, edema and body weight in patients with HF for 1 month. METHODS: This analysis used a descriptive correlational design. Data were collected daily for 30 days from a cohort of heart failure subjects (n=48). Daily mean values and associations between self-reported dyspnea, edema and body weight were determined. RESULTS: The sample included 48 participants with a mean age of 48+/-15 years. Slightly more than half were male (54%) and a majority were married (54%). On average, subjects with HF reported moderate daily levels of self-reported dyspnea and perceived edema. The average daily association between self-reported dyspnea and edema was a positive, significant relationship (p<0.001). There were fewer significant positive associations between self-reported dyspnea and body weight and self-reported edema and body weight. CONCLUSIONS: In this cohort, heart failure patients were able to monitor symptoms daily, detect fluctuations and may be able to modify self-care activities and therapeutic regimen based on these ratings. [ABSTRACT FROM AUTHOR]

BACKGROUND AND RESEARCH OBJECTIVE: Promoting adequate nutritional intake of patients with heart failure (HF) is an essential component of comprehensive management. This goal can be hampered by decreased appetite, as well as psychological, social, and HF-related factors that can affect food intake. Factors related to aging may also affect food intake in older patients. The purpose of this study was to compare patients with HF to healthy elders regarding the extent to which they perceived how appetite and hunger, emotional and social, and illness factors affected the amount of food they ate in the previous week. SUBJECTS AND METHODS: Sixty-seven patients with HF were recruited from 3 Midwestern HF clinics. As part of a larger study examining nutrition in HF, patients filled out the Food Eating Experiences and Diet (FEED) questionnaire, an instrument designed to assess factors affecting appetite and hunger. Patients were asked to rate their hunger and appetite on a visual analog scale. On Likert-type scales, they rated the extent to which appetite/hunger, emotional/social, and illness factors affected the amount of food intake. Sixty-eight healthy elders were recruited from 2 Midwestern senior citizen centers. As part of a study collecting a large data set for comparison with HF patients, healthy elders provided demographic and health information and filled out the FEED questionnaire. RESULTS AND CONCLUSIONS: Factors rated as affecting food intake most often by patients with HF were decreased hunger sensations, diet restrictions, fatigue, shortness of breath, nausea, anxiety, and sadness. Factors rated most often by healthy elders as affecting food intake were diminished hunger sensations, early satiety, eating alone, and decreased senses of taste and smell. Among patients with HF, many factors unique from those present due to age were reported to affect food intake. [ABSTRACT FROM AUTHOR]

PURPOSE: Adults with diabetes were surveyed to determine the extent to which respondents perceived specific preventive regimens (diet, exercise, weight control, and education) had been prescribed or recommended, adhered to their prescribed regimens, and identified barriers to nonadherence. METHODS: Surveys were mailed to 2 samples of adults diagnosed with diabetes. The clinic sample was from health department clinics (n = 264); the agency sample was from a nonprofit agency serving people with diabetes (n = 111). RESULTS: Of the 4 preventive measures under investigation, diet plans and weight reduction were perceived as most commonly recommended by health professionals; exercise schedules were the least commonly recommended. Diabetes self-management education was reportedly recommended more often among the agency sample. In terms of adherence, approximately half of both samples were able to lose weight. A smaller portion of the clinic sample was able to get needed foods and exercise, and maintain weight loss. The most frequently cited reasons for nonadherence were cost, transportation, and other health conditions. CONCLUSIONS: Improvement in the implementation of preventive behaviors is needed, particularly exercise schedules. Barriers to care, such as costs and transportation, may need special consideration. [ABSTRACT FROM AUTHOR]

PURPOSE/OBJECTIVES: To describe eating-related experiences and informational needs of people following total laryngectomies. DESIGN: Descriptive study. SETTING: Internet-based laryngectomy support group in the United States. SAMPLE: 34 people with a laryngectomy (68% total laryngectomy, 29% with total plus radical neck dissection, and 3% with partial laryngectomy with radical neck dissection): 29 males, 5 females; mean age of 62 years. METHODS: Members of a laryngectomy support group completed a Food Eating Experiences and Diet Questionnaire designed by the investigators. Both quantitative and qualitative data were collected. MAIN RESEARCH VARIABLES: Effect of laryngectomy on food choice, eating habits, and overall enjoyment of eating: perceptions of teaching received from healthcare professionals regarding potential eating difficulties as a result of laryngectomy. FINDINGS: 90% of the participants experienced a change in one or more aspects of eating. The most prominent changes were decreased sense of smell, decreased taste, decreased enjoyment of eating, and an increase in the length of time required to eat meals. Most participants were not satisfied with the information they received from healthcare professionals. Topics requiring emphasis during patient teaching were identified from participants' comments. CONCLUSIONS: Total laryngectomy produced significant changes in factors related to eating that can affect nutritional intake and quality of life. Participants reported that most healthcare providers did not adequately prepare them for potential alterations in eating that can occur following a total laryngectomy. IMPLICATIONS FOR NURSING PRACTICE: Data from this study can be used to raise awareness of incidence and severity of changes in eating that occur after total laryngectomy and to improve patient preparation to cope with these changes. [ABSTRACT FROM AUTHOR]