Sleep impairments for caregivers are multifactorial. Assumptions are that caregivers of those with primary malignant brain tumors (PMBT) are similar to caregivers of persons with dementia as cognitive impairments are present at diagnosis. The shorter trajectory of PMBTs and rapid deterioration of recipients’ health may influence sleep in caregivers of persons with a PMBT. The purposes of this study were to use a sleep impairment model to characterize caregiver sleep using objective and subjective measures, and to examine sleep loss effects on psychosocial and physiologic health outcomes. A secondary data analysis using baseline data from a larger study of mind-body interactions in caregivers of family members with PMBTs was used. Caregiver data included standardized questionnaires, serum blood draw, and three-day sleep-wake activity data from an accelerometer. Analyses included descriptive statistics, correlations, t-tests, and hierarchical regression models. Caregivers (N = 133) were White (94%), female (69.2%) spouses (75.2) and on average 52 years old (SD = 11.8). Care recipients were mainly White males of similar age with a highly malignant glioma (57.4%). Sleep latency was longer (35 min, SD = 34.5), with shorter total sleep time (TST) (357 min, SD = 84.6) and more frequent wake after sleep onset (WASO; 15.1%, SD = 9.2) than in the general population. Caregivers reported high anxiety (59.4%). Caregiver comorbidities and care recipient functioning explained higher perceptions of health (R2 = 26, F(2, 84) = 14.94, p < .001). Whereas, longer TST, more WASO and poorer sleep quality explained poorer quality of life (R2 = .27, F(4, 66) = 6.19, p < .001). Sleep loss variables explained little variance in physical health status, interleukin-1ra and interleukin-6 levels, fatigue, depressive symptoms, spiritual health, social support, and work limitations. Nurses need to assist caregivers with anxiety management and ways to improve sleep at time of PMBT diagnosis. Sleep impairments place these caregivers at risk for physical and mental health problems, and compromise their ability to continue in the role.

The prevalence of hypertension (HTN) is high in Latinos (Latino/Latina) Americans due to social and ecological factors. Increased migration of Latino migrant/seasonal farmworkers (MSFW) to the U.S. augments the social, economic, environmental, and psychosocial factors associated with health and illness. Bronfenbrenner’s Ecological Systems Theory was used to guide this study. The purposes of this cross-sectional, correlational study were to explore Latino MSFWs’ adherence to HTN treatment (medication adherence, blood pressure [BP] self-care, and BP control) and to examine the influence of BP knowledge, perceived stress, acculturation, health literacy, and health care access (HCA) on adherence to HTN treatment. A total of 45 Latino (mean age 45 + 9) MSFWs receiving HTN treatment participated in this study. Spanish and English questionnaires were available for participants to measure adherence to HTN treatment and the five independent variables. Analysis included correlations, t-tests, hierarchical multiple regression, and hierarchical logistic regression. The majority of MSFWs were from Mexico, female (55.6%), had less than a 6th grade education. Most (82%) of the MSFWs had uncontrolled BP, and were not adherent to medications (42%), even with high BP knowledge scores (M = 6.5 ±1.3). MSFWs perceived a high level of stress (M = 16 + 6.9), low acculturation level (Anglo orientation: M = 2.9 + 0.9), and no employer-provided health insurance for personal illnesses or injuries (93%). Blood pressure knowledge, perceived stress, acculturation, health literacy, and HCA accounted for 49% of the variance in the BP self-care; however, only higher BP knowledge was a significant predictor of better BP self-care (p < .001). Furthermore, acculturation was a significant predictor of BP control (p < .01). This study explored select determinants of adherence to HTN treatment in Latino MSFWs in a culturally informed way. Although BP self-care behaviors appeared to be a consequence of BP knowledge, this study found low medication adherence in Latino MSFWs and uncontrolled BP explained by the two predictors, acculturation and health literacy. Perceived stress and health care access did not influence the adherence to HTN treatment. MSFWs had poor BP control and HTN treatment adherence. A culturally appropriate educational program is needed to help the MSFWs adherence to HTN treatment.

Although there is a growing body of research in the area of adolescent pregnancy and parenting, relatively little research has addressed the psychological effects of pregnancy on the adolescent. A descriptive correlational study was utilized to examine levels of depressive symptomatology, self-esteem, perceived social support from family and friends, and the relationship among these variables in the pregnant adolescent. A second purpose of the study was to describe characteristics of the pregnant adolescent (age, race or ethnicity and educational level). The theoretical framework for this study was derived from The Conceptual Model of Support During Adolescent Pregnancy. Participants for the study were recruited from two school programs for pregnant adolescents, a physicians office, and a clinic. A convenience sample of 90 single pregnant teens between the ages of 13 to 18 participated in the study. The teens completed a demographic form and four questionnaires: the Reynolds Adolescent Depression Scale, the Rosenberg Self-Esteem Scale, the Perceived Social Support from Family Scale, and the Perceived Social Support from Friends Scale. Demographic data were analyzed using descriptive statistics. A one-way analysis of variance (ANOVA) was computed to determine the significance between the depression scores and each of the demographic variables. The relationship between the adolescent's total depression score and self-esteem, perceived family support, and perceived peer support were determined by computing Pearson product-moment correlations. Regression analyses were conducted to determine the best linear model to explain the variance in the total depression scores and the combination of the independent variables (self-esteem, perceived social support from family, and perceived social support from friends) in the pregnant adolescent. Thirteen (14%) of the adolescents exceeded the cutoff score of 77. The regression analysis of the RADS-2 score on the predictor variables (self-esteem, perceived support from family, and perceived support from friends) accounts for 56.9% of variance in depression of adolescents during pregnancy. The adolescents in this study who experienced increased self-esteem and perceived support from family and friends had decreased scores on the RADS-2 scale. Increased self-esteem or feelings of self-worth was the most significant variable in this study as a predictor of depressive symptomatology.

Background: Chronic pelvic pain (CPP) in women causes significant disability and distress. Like other chronic pain conditions, psychosocial variables likely play as key a role in the development and maintenance of CPP as physiological ones. The purposes of this study were to use the Biopsychosocial model to determine the predictors of pain and quality of life (QOL) and to specifically examine to effect of baseline catastrophizing on 12-month pain and QOL. Methods: Secondary analysis of baseline and 12-month data collected from women presenting for CPP treatment (n = 673) at a tertiary referral center was performed. Questionnaires assessed medical symptoms, physical and mental health, abuse, trauma, catastrophizing and the main outcome measures of pain reports (McGill Pain Questionnaire) and QOL scores (adapted version of the Irritable Bowel Syndrome QOL Questionnaire). Results: Of the 673 enrolled, 401 completed baseline questionnaires. These women were predominantly middle aged (M = 35.68, SD = 9.87), married (66%), Caucasian (78%), and educated (M = 14.83, SD = 2.55). Two hundred seventy-two women completed questionnaires at baseline and 12 months and were similar in most characteristics but reported fewer incidents of trauma and abuse, improved physical health and fewer medical symptoms. Women experienced a significant reduction in pain (t (261) = 11.23, p < .001) and improved QOL (t (257) = 6.78, p< .001). Baseline catastrophizing was a predictor of baseline pain (R2 = .42, pβ = .46, p < .001) and baseline QOL (R2 = .79, p< .001; β = .71 p < .001) with similar results at 12-month follow-up. While baseline catastrophizing contributed only 3% of the variance it remained a significant predictor of 12-month pain (R2 = .39, p < .001; β = .18, p = .003). Unexpectedly, abuse and trauma histories were not significant predictors of pain or QOL. Conclusions: These findings contribute to the existing body of literature by confirming the complex nature of CPP and suggest that psychological processes such as catastrophizing play a vital role in CPP. Future research in CPP will benefit from the exploration of the contribution of psychological processes to CPP and the application of research from other pain conditions to gynecologic pain disorders.

Men who have sex with men (MSM) are disproportionately affected by HIV infection and account for more than half of all new HIV infections diagnosed in the U. S. The purpose of this study was to explore factors that influence sexual behavior among sexually active HIV positive MSM using constructs from the health belief model (HBM). A cross-sectional, correlational study was conducted with a non-randomized sample of 216 HIV positive MSM. Participants were predominantly Black/African American (85.6%). The mean age of the sample was 43.02 years (SD = 9.74) and ages ranged from 19 to 66. More than 90% reported a high school educational level or greater; and nearly half (47.2%) had been diagnosed with HIV for more than 10 years. The overall model predicted that participants who had perceived less severity of living with HIV and who had a positive attitude toward condom use were more likely to practice safer sex, accounting for 24% of the variance in sexual behavior (p < .001). When controlling for demographic characteristics (age, number of years diagnosed as HIV positive, number of recent sexual partners, and current antiretroviral medication use), the overall model accounted for 41% of the variance (p < .001). Participants who had a fewer number of recent sex partners and who had a positive attitude toward condom use were more likely to practice safer sex. Additionally, those who practiced safer sex (n = 58, 27%) reported significantly higher levels of perceived severity of living with HIV (p = .037), perceived benefits of safe sex (p = .018), perceived barriers to safe sex (p < .001), and self-efficacy for negotiating safe sex (p = .013) compared to those who did not practice safer sex (n = 157, 73%). Results from the study indicated there was a high prevalence of unsafe sexual practices among the participants. These findings support the need for additional research to explore factors that influence sexual behavior among HIV positive MSM with an emphasis on testing interventions that support safe sex practices.

ABSTRACT THE EXAMINATION OF FACTORS THAT INFLUENCE TREATMENT SEEKING DELAY AMONG OLDER ADULTS DIAGNOSED WITH ACUTE MYOCARDIAL INFARCTION By Deonna S. Tanner Early diagnosis and treatment of acute myocardial infarction (AMI) can greatly reduce the morbidity and mortality associated with this condition. However, individuals, particularly older adults, delay seeking treatment for AMI symptoms. The purpose of this study was to examine the relationship of factors that influence pre-hospital delay in seeking treatment among older adults diagnosed with AMI. A descriptive, cross-sectional, comparative study design with a correlational component was used. Data were collected from 82 hospitalized older adults (60-80 years of age). For statistical analyses, older adults were divided into two groups. The shorter delay group delayed ≤ 120 minutes from the onset of symptoms (OS) and the longer delay group delayed > 120 minutes. Using the Common Sense Model as a guide, groups were compared on the following variables: internal influences (age, gender, race, history of AMI) and external influences (personal and professional support), cognitive representations of symptoms (symptom interpretation, perceived level of control, seriousness), and emotional representations of symptoms (anxiety and uncertainty). The majority of participants were retired/unemployed (64.6%) White men (82.9%) who were married (73.2%) with a mean age of 69.04 (± 5.82) years. The median delay time was 2.6 hours (range 0.5 - 432 hours). Participants experienced on average eight (± 3.86) symptoms (typical and atypical) with high levels of pain (M= 7.1 ± 3.4) and high state anxiety (M = 56.47 ± 10.37) at the time of the AMI. Findings show the only significant independent predictor of delay time was personal support. Being more certain that symptoms were heart related or having a previous AMI resulted in significantly shorter delay time (p <.05). Contacting a healthcare provider was not helpful for these older adults. Findings show factors influencing delay are challenging and complex, yet laypersons play an important role in the decision to seek treatment. Future research should include community-based educational programs focusing on atypical AMI symptoms and ways to increase the activation of emergency medical services soon after the OS.

Genetic epilepsy with febrile seizures plus (GEFS+) is associated with a wide range of neurological dysfunction caused in part by limited function in voltage-gated sodium channels (Escayg & Goldin, 2010; Gambardella & Marini, 2009; Mulley et al., 2005). The seizure and behavioral phenotypes, as well as use of non-pharmacologic agents as neuroprotectants in GEFS+, are not well-understood. An experimental design used an animal model of GEFS+ to 1. explore the effects of stress on seizure phenotype, 2. examine behavioral phenotypes, and 3. study the effects of an omega 3 fatty acid on abnormal behaviors noted in the various paradigms. This study used C57BL/6J mice with the R1648H missense mutation on the Scn1a gene (engineered in the Escayg lab) (Martin, M. S. et al., 2010). The three specific aims used separate groups of animals for experimentation, and all paradigms were performed under strict laboratory conditions. Data were analyzed using either an independent t-tests, two-way ANOVA or repeated measures two-way ANOVA. Results showed that stress worsens seizure phenotype in both the Scn1aR1648H (RH) mutants and wild-type (WT) group with the RH mutants more severely impacted. In addition, there was clear and consistent evidence for hyperactive locomotor behavior. Lastly, no evidence was found for use of docosahexaenoic acid (DHA, an omega 3 fatty acid) as a neuroprotectant for hyperactivity (DHA was given subcutaneously for two weeks starting at weaning). Outcomes from this study implicate that stress worsens the seizure phenotype in animals with Scn1aR1648H. This study is also the first to report hyperactive locomotor behavior in animals with Scn1aR1648H. Results from this study may broaden beyond GEFS+ in that we may also be able to apply the findings to other disorders with SCN1A dysfunction. In addition, it may be that genetic variants affecting SCN1A, but not necessarily in epilepsy, may contribute to hyperactivity. This could mean that SCN1A is a candidate gene for hyperactivity. The main goal of nursing care is to reduce and prevent disease morbidity, and knowledge gained from the current study will guide clinical nursing practice, such as targeted behavioral assessment and education, as well as nursing research focusing on children with this genetic disorder.

First responders who participate in disaster are at risk of posttraumatic stress disorder (PTSD). Because of nurses’ unique role as professional and volunteer responders, there is a need to know more about risks of PTSD in this group. Using a cross-sectional correlational design, associations between disaster exposure, problem focused coping (PFC), emotion-focused coping (EFC) and PTSD symptoms (Impact of Events Scale-Revised (IES-R) scale) were explored. A random sample (n= 995) was drawn from a list of nurses from the New Orleans region. Each nurse was mailed an invitation to participate in an online survey. Three post-card reminders were sent. The sample was divided into nurses who participated in disaster activities (n=76) and those who did not (n=32). Prevalence of PTSD in the PIDA nurses was 13.2%. Almost half the PIDA nurses (48.7%) reported symptoms of PTSD, and increased use of substances to cope (31.5%). Only 9.2% sought psychological care post-event. Regression analyses, controlling for history of trauma, marital status, and gender found EFC accounted for a significant amount of the variance of symptoms of PTSD (R2 = 0.32, F (1, 67) = 25.09, p < 0.001) (B=0.4, SE=0.01, p Prevalence of PTSD among PIDA nurses was lower than other groups of professional responders (17.4% in firefighters), but greater than the general public (6.8%). Presence of PTSD in PIDA nurses five years after Hurricane Katrina is associated with the increased use of EFC and substances.

Women with gestational diabetes (GD) are at higher risk of developing type 2 diabetes (DM) after delivery compared to those without GD. Numerous studies in the general population have identified that adoption of healthy lifestyles can prevent DM; however limited research has focused on women with GD. The purpose of this randomized pilot study was to determine the effectiveness of an educational intervention of SUGAR (Start Understanding Gestational Diabetes and Risk of Type 2 Diabetes), on women’s perceived risk of developing DM, knowledge of DM, self-efficacy to adopt healthy lifestyle behaviors and adoption of healthy lifestyle behaviors after childbirth among women with GD. A total of 23 women (mean age of 29.7, SD=3.9), 18 in SUGAR group and 5 in control group (CG) completed self-reported standardized questionnaires (Risk Perception Survey for Developing Diabetes adapted for women with GD; Self-Rated Abilities for Health Practices; Health Promotion Lifestyle Profile II; General Sleep Disturbance Scale; and Demographic Questionnaire) at baseline (third trimester) and post-test (postpartum 6-8 weeks). Intervention was given post the baseline data collection with a booster session at 2-4 weeks postpartum. The women in CG received attention control treatment. Study participants were obese (BMI M=33.1, SD=7.7) and a majority had a family history of DM. Findings showed that self-efficacy was the single significant predictor and accounted for 22% of the variance of healthy lifestyle behaviors. Participants had a clinical significant sleep disturbance during both pregnancy and postpartum. At baseline, poor sleepers reported a lower self-efficacy. The intervention significantly increased DM knowledge for women in the SUGAR group; however, not for perceived risk, self-efficacy nor healthy lifestyle behaviors. There was no difference between groups for postpartum glucose screening rates with only 39% receiving recommended testing. Future research needs to focus on prevention programs and center on self-efficacy, postpartum glucose screening, improve sleep, and adoption of healthy lifestyle behaviors. To ensure a better preventive care for GD women, education provided for both patients and health care provider is needed.

African American women living in the U.S. face immense challenges to protect themselves from HIV infection. One in every 32 African American women is diagnosed with the disease and heterosexual contact is the primary mode of transmission. A better understanding of the African American woman’s beliefs and decisions related to safe sex practices can give direction to strategies to promote safer sexual behaviors. The purpose of this study was to explore the association of the African American woman’s attitudinal beliefs, normative beliefs, and relationship control beliefs with self-reported sexual behaviors. The Theory of Planned Behavior served as the study’s theoretical framework, supporting the premise beliefs are precursors to explanations and understanding human behavior. Using a cross-sectional, correlational design, a convenience sample of 95 African American women from the southeastern United States was obtained. Results confirmed a statistically significant 1) positive relationship between gender role beliefs and relationship power, (r = 0.354, p < .001); 2) negative relationship between gender ratio imbalance beliefs and relationship power, (r = -0.472, p < 0.001); 3) positive association between relationship power and avoidance of risky sexual behavior, (r = 0.340, p = 0.001); 4) negative correlation between gender ratio imbalance beliefs and risky sexual behaviors, (r = -0.235, p = 0.022); and 5) positive correlation between safer sexual behavior and peer perceptions of safer sex behaviors, (r = 0.475, p < 0.001). Results from a stepwise multiple regression indicated that relationship power (p = 0.001) and peer perception (p < 0.001) were significant predictors of sexual behavior, accounting for 31% (p < 0.001) of the variance.