The physiologic response to hypoxia may be determined by variables such as exposure pattern and inducible nitric oxide synthase (iNOS) expression. Blood pressure (BP) and heart rate (HR) responses to daily exposure (X 3 days) of intermittent hypoxia (IH) vs. continuous hypoxia (CH) (equivalent total exposure time) were compared. The relation between BP and HR responses and iNOS expression under IH and CH conditions was also examined. On 3 consecutive days, 10 normal males had six 10-min. hypoxic exposures (oxyhemoglobin saturation, SpO2: 80-90%), with each exposure separated by 10 min. of normoxia. Subjects also had 3 consecutive days of CH (60 min/day; SpO2: 80-90%). IH and CH exposure blocks were separated by a greater than 7 days. BP, HR, and SpO2 were recorded during the 5 min. prior to and the last 5 min. of each daily IH and CH exposure. Venous blood for iNOS mRNA was obtained before exposure on day 1, and 2 hrs. after the last exposure on day 3. HR, systolic and diastolic BP were significantly (p less than 0.05) increased from baseline- to end-exposure on each day, regardless of IH or CH. There was a significant negative correlation (p less than 0.01) between both diastolic and mean BP with iNOS at the end of the day 3 IH session. Hypoxic stress reflected by IH and CH is associated with significant, but comparable changes in BP. Negative correlation between BP and iNOS mRNA in conjunction with IH, but not CH, exposure suggests that the hemodynamic response to IH may be modulated by iNOS.

Heart failure, a serious and prevalent chronic disease, places a large psychosocial burden on patients and their families. The research presented in this dissertation focuses on the complex relationship between social support and personal control and two key psychological outcomes depression and anxietyin individuals coping with heart failure. Theoretically defensible models are developed, drawing on an integrative stress coping framework, and appropriate inferential statistical procedures are implemented to identify the importance of the proposed relationships in a sample of 242 adult men and women being treated for cardiomyopathy. Two structural models are evaluated. Model 1 examines the mediating influence of personal control between social support and depression, while Model 2 examines the mediating influence of control between social support and anxiety. Statistically significant estimates indicate that social support plays a key role in reducing psychological distressdepressive symptoms and anxiety. The mechanism whereby social support effectively reduces psychological distress is entirely through patients perceived control. An additional objective of the study is exploration of gender differences in the two models. A series of empirical analyses, using path analysis and regression-based mediation models, indicate that among heart failure patients there are indeed statistically significant gender differences in the relationships between social support, control, and psychological functioning. These differences were contingent on the measurement of control included in the model. Evidence suggests that the role of social support is greater for women than for men in reducing psychological distress, as indicated by either depressive symptoms or anxiety.

Background: Understanding factors that affect decision-making in using preconception planning is important in order to reduce the rate of unplanned pregnancies and pregnancy-related complications in all women with type 1 diabetes (T1D). Previously, there were no studies of reproductive health-related beliefs, attitudes, or behaviors of adolescent women with diabetes. Constructs from social cognitive models, such as, the Health Belief Model (HBM), Theory of Reasoned Action (TRA), and Social Cognitive Theory (SCT), are factors that can influence these behavioral outcomes. Objective: Three theories were each tested in terms of goodness of fit with respect to decision-making with reproductive health behaviors in female teens with diabetes; and to identify a composite model of the most significant predictors across all three theories. Method: Secondary analysis was conducted from a data set from a cross-sectional study. Data were collected from a telephone interview by same-gender research assistants on a sample of 87 female adolescents with T1D from four medical centers using the ¡§Reproductive Health Attitudes and Behavior¡¨ (RHAB) Questionnaire. Measures represent demographic, psychosocial, constructs of the three theories, and behavioral outcomes. Logistic regression analyses were used to examine the prediction of the three theories in the outcome variable (birth control use in the future). Results: Good model-fit were found for both the HBM (Nagelkerke R2= .66) and TRA (Nagelkerke R2= .47). The composite model consisted of perceived barriers, cues to action, personal attitude, intention, and age, which were statistically reliable in predicting the future use of birth control in the female teens with diabetes. Perceived barriers (OR= .56, 95% CI= 0.32-0.97), cues to action (OR= .25, 95% CI= 0.10-0.61), personal attitude (OR= .72, 95% CI= 0.59-0.87) and intention (OR= .70, 95% CI= 0.50-0.97) were the strongest predictors among all constructs. Conclusion: Perceived barriers, cues to action, personal attitude, and intention appear to predict birth control use in the future in this sample of adolescent females with T1D. Intervention studies to prevent future unplanned pregnancies in this high-risk population could focus on strategies to target these factors that are amenable to change.

Tobacco use continues to be the leading cause of morbidity and mortality in the United States. Public Health Service sponsored clinical guidelines support smoking cessation interventions at every clinical encounter with a smoking patient. The primary aim of this research protocol proposed to examine the efficacy of a 12-week nurse-delivered relapse management intervention designed with conceptual underpinnings from Self-efficacy Theory to enhance smoking abstinence of hospitalized smokers following their hospital discharge. A randomized, controlled two-group design with an intent-to-treat approach was used. The sample consisted of 80 consenting smokers prospectively recruited during hospitalization. Subjects were randomly assigned by equal allocation to a special intervention group (SI) or an enhanced usual only group (UC). All subjects received enhanced usual care. Participants assigned to the intervention group received 8 telephone intervention sessions with a nurse over 11 weeks after discharge. Intervention was directed towards enhancing self-efficacy to maintain tobacco abstinence. Follow-up visits occurred 12 and 24 weeks following hospital discharge. Data collection included smoking point prevalence with validation by exhaled carbon monoxide. At 12 weeks, 20% (n = 8) UC and 40% (16) SI subjects were abstinent (LRÓ2 = 4.87, df = 1, p = .014). At 24 weeks, 15% (n = 6) UC and 42% (n = 16) SI subjects were abstinent (LRÓ2 = 7.69, df = 1, p = .004). There were significant differences between treatment assignments, particularly when confounding variables for current employment and greater lengths of hospital stay were controlled in the analyses. Self-efficacy with the Relapse Situation Efficacy Questionnaire was predictive of 12-week smoking status. Treatment adherence was significantly related to smoking behavior in the treatment group. The two groups did not differ in smoking lapse or with self-efficacy over time. Recruitment sites did differ with respect to smoking status, but only at 12-weeks after discharge. There were no significant cohort differences. Future research is needed to improve tobacco abstinence following hospitalization and to examine treatment adherence with an emphasis on strategies for improvement of treatment adherence with hospitalized smokers.

Mental disorders cost the United States approximately 170 billion dollars in just one year (HHS, 2002). The onset of a diagnosable mental disorder such as anxiety, depression, and substance abuse can begin in adolescence. Rural adolescents are at risk for negative outcomes due to psychosocial/socioeconomic stressors and a lack of access to health care. This secondary data analysis used a cross-sectional sample of 466 adolescents from four rural high schools in western Pennsylvania to examine the relationships among demographic variables (age, gender, birth order, parents present in household, subject having a job), stress (life events), psychosocial factors (optimism, perceived social support, coping), and the outcomes of anxiety, depression, and substance abuse (alcohol, drugs, smoking). Lazarus Theory of Stress and Coping and Lerners Developmental Contextualism was used to form the theoretical framework. Descriptive statistics, correlational and regression analysis were the primary methods of analysis. Over 33% of the subjects reported depressive symptoms; 20% reported higher levels of anxiety symptoms. Approximately 74% report that they have used alcohol at least once; 53% report having tried at least one other drug such as cocaine or marijuana. Over 38% smoke cigarettes at least occasionally. Gender differences were found in the sample. Females reported greater anxiety and depressive symptoms than males. Gender had both a direct and indirect effect on the outcomes of anxiety and depression with negative life events and psychosocial factors (optimism, social support, and coping) acting as mediators. Stress, optimism, perceived social support of family, and avoidance coping were found to have a mediating effect on the relationship between demographics and substance abuse. The results of this study support the proposed model and the hypotheses that stress and psychosocial factors are mediators between the relationships among the demographic and outcome variables. Empirical data gathered and reported in this and other studies will assist health care professionals (e.g., physicians, nurse practitioners, and school nurses) to develop and implement interventions that target mediating variables such as coping. These interventions have the potential to improve rural adolescents ability to socialize, adapt, and cope; assisting them in making better decisions and growing into productive, healthier adults.

Purpose: This study examined the relationships among variables derived from Ajzens Theory of Planned Behavior (TpB) in order to explain intentions of premarital sex and condom use in Korean college students. Methods: This study used a cross-sectional, correlational design using an exploratory survey methodology through self-reported questionnaires. Several instruments were used to measure the variables studied. Students aged 18-25 were recruited from a university in Seoul, Korea using a flyer and self-referral (male =165, mean age: 22.6; female=133, mean age: 20.67). Since there was a small amount of missing data (6.88%) and no differences in sample characteristics between the missing (n=22) and the non-missing groups (n=298), list-wise deletion was performed. The analytic approach included descriptive statistics, spearman rank correlation, and multi-sample structure equation modeling. All instruments showed good reliabilities. Cronbachs alphas were used to examine internal consistencies of the instruments (alpha=0.77 - 0.98). Results: Forty nine percent of male students and around 12% of the female students had engaged in premarital sex; however, only 26.7% of sexually active students always used condoms. Looking at the model of premarital sex, premarital attitude was the strongest predictor of intention of premarital sex for both genders. For males, the TpB components of attitude, perceived behavior control, subjective norms explained intention of premarital sex; however, perceived behavioral control did not predict intention of premarital sex for females. A Lagrange Multiplier (LM) test showed that male and female students had different models to explain intention of premarital sex (S-B chi-square test(22) =20.55, p=0.55, CFI=1.00, RMSEA=0.000). Looking at the model of condom use, condom efficacy was the strongest predictor of intention of condom use, and all TpB components significantly predicted intention of condom use. Higher condom efficacy predicted a higher intention. The LM test showed that male and female students shared one model to explain this intention (S-B chi-square test(17) =22.72, p=0.16, CFI=0.98, RMSEA=0.03). Conclusion: The TpB has demonstrated applicability for predicting intentions of premarital sex and condom use as a way to decrease risky sexual behavior within the Korean culture. Findings provide information for developing better sex education programs for Korean late adolescents and young adults.

Medical emergency teams (METs) were developed to more rapidly respond to changes in patient condition that might result in a preventable death. While effective, MET do not address events which precede the call for a response. Such information could provide direction for interventions that avert the need to initiate a MET response or identify the need to do so more quickly. This study examined differences in patient, nurse, and organizational characteristics for 108 MET calls involving patients on five medical and five surgical units in a tertiary care hospital. MET activations occurred more often on the 7AM-7PM shift than the 7PM-7AM shift (p¡Ü .007) for medical patients (p=.036) but not surgical patients. Of the 108 events, 44% were delayed events, defined as events with documented evidence in the medical record that pre-established criteria for calling the MET were present for > 30 minutes. More delays occurred on the 7PM-7AM shift (p=.012) for surgical patients (p=.036) but not medical patients. Delayed events were not significantly related to the number of medical or surgical patients the nurse was assigned (p=.608). However, there was a trend for more delays when more patients were assigned (4:1 = 21% vs 6:1= 43%). In a logistic regression model, the variables of shift (7AM, 7PM) and care on a unit designated for medical or surgical patients were significant predictors of delay. Shift was associated with a significance level of .009 and a 3.25 greater likelihood (95%CI, 1.34-7.9) of a delay occurring on the 7PM shift. Receiving care on a designated unit was associated with a significance level of .014 (OR, .07; 95%CI, .009-.579). These findings have implications for patient safety by demonstrating avoidable delays in responding to clinical deterioration. Study findings suggest that a combination of patient, nurse, and organizational characteristics influence the timely rescue of hospitalized patients.

The purpose of the study was to identify predictors of physical injury in adolescent and adult women, who have a medical history of rape. Severity of rape-related injury is linked to negative health consequences. Studying the impact of injury and the associated predictors expands the understanding of rape and the risks of long-term negative health consequences. Variables included regional setting, victim characteristics (age, ethnicity, and known or unknown perpetrator) and forensic characteristics (time from rape to examination, weapon presence, multiple perpetrators, and use of an evidence kit). Secondary analysis evaluated cross-sectional data of women (N = 3318) 13 to 89 years of age (M = 26.6; SD = 11.1) from three regions of the US: the northeast, the southern coast, and the west coast. The results of multiple logistic regression models included main and interaction effects, primarily involving setting and ethnicity variables. The forward stepwise model (chi-square [18] = 387.26, p = .001) demonstrated adequate fit based on the Hosmer-Lemeshow goodness-of-fit results (chi-square [7] = 5.72, p = .57), and was a slightly improved fit over the backward elimination model (chi-square [22] = 398.12, p = .001), which also had desirable Hosmer-Lemeshow chi-square results (chi-square [7] = 7.47 p = .38). The forward and backward models included ten significant interactions: Setting C by age, Setting C by examination time of >72 hours, Setting A by other ethnicity, Setting A by weapon presence, Setting A by examination time of 48-72 hours, and Setting A by multiple perpetrators, age by weapon presence, African American by examination time of 24-48 hours, African American by multiple perpetrators, other ethnicity by examination time of >72 hours, and unknown perpetrators by multiple perpetrators. Implications of this research emphasize the importance of location and ethnicity on documentation of injury and 1) can lead to refinement of data collection, 2) addresses the need for research in the acute time frame after rape, 3) informs tailored interventions, 4) links health and legal systems to improve forensic management, 5) emphasizes the need for multi-professional funding allocation for education, prevention and interventions to improve victim care.

The rural community has lacked adequate healthcare providers for the past thirty years. Collaboration between physician and family nurse practitioner is an option for meeting the need for delivery of primary healthcare in the rural community. A descriptive design was used to describe the acceptance of the nurse practitioner by patients living in rural southcentral Kentucky who utilize the services of the community hospital. Every fifth inpatient and outpatient discharge was mailed the Kviz Assessment Questionnaire and a demographic survey. The questionnaires (N = 842) were mailed over a four week survey period with reminder postcards mailed to each survey recipient one week after the initial mailing. The return rate was 32% (N = 267). Respondents were asked if they would allow a specially trained nurse practitioner to perform 12 specific functions, of which 4 were traditional and 8 were nontraditional. The majority of the respondents indicated acceptance of the traditional and nontraditional functions. Use of chi-square analysis identified a statistically significant relationship between the willingness to accept nontraditional nursing functions and (a) respondents who were satisfied with their usual source of care [X2 (4, N = 230) = 5.93, p = .01]; (b) respondents who obtained regular check-ups [X2 (4, N = 239) = 6.53, p = .01]; (c) respondent age [X2 (6, N = 238) = 7.27, p = .03]; and (d) respondents who felt there is an insufficient quantity of physicians available [X2 (6, N = 225) = 10.83, p = .01].

The findings indicated no significant differences among the age groups in relation to infant birth weight nor in relation to the risk factors of smoking, maternal weight gain, trimester of first entry into prenatal care, or marital status They did indicate a significant difference [F(2,85) = 4.1364, p < .05] between the oldest and the youngest group (CD = 3.37, a = .05) in relation to gestational length. These findings are significant for healthcare providers in rural areas, since much of the previous research had been done in highly urbanized or inner city settings.