This site is an archive of a closed Robert Wood Johnson Foundation program, provided for educational and historical purposes. Please note that this content is not routinely updated and that contact information and social links may not work.
Recent Research Publications and Funding
-
|
November 19, 2010 6:00AM
Dr. Hart intended to answer the question of whether or not radon is deadly in Montana. Instead he answered the question, “Do Environmental Protection Agency (EPA) county zone designations correlate to statistically different rates of lung cancer deaths in Montana?” Based on a non-significant student t-test comparing mean cancer mortality for EPA zone 1 and 2 designated counties, Dr. Hart concluded the “notion” that radon is deadly in Montana should be questioned. Dr. Hart’s analysis is flawed.
-
|
November 8, 2010 6:00AM
Purpose/Objectives: To present the novel Symptom Cluster Experience Profile (SCEP) framework for guiding symptom research in adult survivors of childhood cancers and other subgroups at risk for high symptom burden.
Data Sources: Empirically derived model of symptom cluster experience profiles, existing theoretical frameworks, and data-based literature on symptoms and quality of life in adult survivors of childhood cancers.
Data Synthesis: In a previous study, the authors generated a preliminary model to characterize subgroups of adult survivors of childhood cancers with high-risk symptom cluster profiles. The authors developed the SCEP framework, which depicts symptom cluster experiences as subgroup-specific profiles that are driven by multiple sets of risk and protective factors. The risk and protective factors may directly and indirectly contribute to or alleviate symptoms through their effects on systemic stress. Systemic stress instigates and sustains the symptom experience that, in turn, is expressed through negative diffusion into other components of quality of life, such as functional status, general health perceptions, and overall quality of life.
Conclusions: The SCEP framework is an initial approach to unbundle the complex heterogeneity that underlies the clustering of symptoms. By measuring a wide range of risk and protective factors in future studies of adult survivors of childhood cancers and other subgroups at risk for high symptom burden, further development and validation of the SCEP framework will occur.
Implications for Nursing: The SCEP framework can be used to specify mechanisms underlying symptom cluster profiles and derive interventions targeted to high-risk symptom profiles. Findings from future studies can be translated to risk-based surveillance and symptom management clinical practice guidelines.
-
|
November 8, 2010 6:00AM
Purpose/Objectives: To present the novel Symptom Cluster Experience Profile (SCEP) framework for guiding symptom research in adult survivors of childhood cancers and other subgroups at risk for high symptom burden.
Data Sources: Empirically derived model of symptom cluster experience profiles, existing theoretical frameworks, and data-based literature on symptoms and quality of life in adult survivors of childhood cancers.
Data Synthesis: In a previous study, the authors generated a preliminary model to characterize subgroups of adult survivors of childhood cancers with high-risk symptom cluster profiles. The authors developed the SCEP framework, which depicts symptom cluster experiences as subgroup-specific profiles that are driven by multiple sets of risk and protective factors. The risk and protective factors may directly and indirectly contribute to or alleviate symptoms through their effects on systemic stress. Systemic stress instigates and sustains the symptom experience that, in turn, is expressed through negative diffusion into other components of quality of life, such as functional status, general health perceptions, and overall quality of life.
Conclusions: The SCEP framework is an initial approach to unbundle the complex heterogeneity that underlies the clustering of symptoms. By measuring a wide range of risk and protective factors in future studies of adult survivors of childhood cancers and other subgroups at risk for high symptom burden, further development and validation of the SCEP framework will occur.
Implications for Nursing: The SCEP framework can be used to specify mechanisms underlying symptom cluster profiles and derive interventions targeted to high-risk symptom profiles. Findings from future studies can be translated to risk-based surveillance and symptom management clinical practice guidelines.
-
|
November 1, 2010 4:00AM
Purpose: To assess the feasibility of whether mindfulness-based stress reduction (MBSR) has a positive effect on breast cancer survivors’ psychological status, psychosocial characteristics, symptoms, and quality of life (QOL) during the critical transition period from end of treatment to resumption of daily activities.
Design: Single-group, quasi-experimental, pretest–posttest design. Method: A sample of 19 women who completed breast cancer treatment with lumpectomy, radiation, and/or chemotherapy was recruited from the Moffitt Cancer Center and Research Institute, a National Cancer Institute– designated cancer center, and the University of South Florida. The authors assessed the feasibility, compliance, and whether an 8-week MBSR program positively influenced changes in psychological status (fear of recurrence, perceived stress, anxiety, depression), psychosocial characteristics (optimism, social support, spirituality), physical symptoms, and QOL. Findings: Seventeen women (89.5%) com- pleted the study. The mean age was 57 years; the majority of participants (94%) were white. The estimated compliance rate for the program was 67%. Paired t tests indicated significant improvements fear of recurrence, perceived stress, anxiety, depression, and QOL through MBSR participation.
Conclusions: Participants enrolled in the MBSR classes generally were compliant. Significant improvement in psy- chological status, symptoms, and QOL can be achieved with MBSR use in this population.
-
|
October 28, 2010 4:00AM
Nurses often help patients cope with loss. Recent research has cast doubt on the validity of early theories about loss and grief commonly taught to nurses. We systematically examined the accuracy of information on coping with loss presented in 23 commonly used undergraduate psychiatric nursing books. All 23 books contained at least one unsupported assumption (myth) about loss and grief. In 78% of these books, authors described four or more myths and only one evidence-based finding about coping with loss. On balance most books provided details on the myths about grief and loss with minimal discussion of the current evidence. Authors of psychiatric nursing books continue to disseminate unsupported theories about grief responses without adequately acknowledging evidence challenging core assumptions underlying them.
-
|
October 1, 2010 4:00AM
Pain assessment conventionally has been viewed hierarchically with self-report as its "gold-standard." Recent attempts to improve pain management have focused on the importance of assessment, for example, the initiative to include pain as the "fifth vital sign." We question the focus in the conceptualization of pain assessment upon a "vital sign," not in terms of the importance of assessment, but in terms of the application of self-report as a mechanistic index akin to a biologic measure such as heart rate and blood pressure. We synthesize current inclusive models of pain and pain assessment and propose a more comprehensive conceptualization of pain assessment as a transaction based on an organismic interplay between the patient and clinician.
-
|
September 30, 2010 4:00AM
The purpose of this secondary data analysis was to evaluate the adverse events associated with a restorative care intervention (Res-Care) in nursing home (NH) residents. A randomized controlled repeated-measure design and generalized estimating equations were used to evaluate status at baseline and 4 and 12 months after initiation of the Res-Care Intervention. The Res-Care Intervention was a 2-tiered self-efficacy-based intervention focused on motivating nursing assistants to actively engage residents in functional and physical activities. The measurements included baseline (2-month pre-intervention), 4-month, and 12-month records of adverse events, including falls, fall-related injuries, fractures, emergency room (ER) visits, hospital admissions, and death abstracted from NH records. The results showed that there were significant baseline differences between treatment groups in resident race (more African Americans in control sites) and ER visits (more visits in treatment sites 2 months before intervention). Longitudinal models revealed significant differences in ER visits at 4 months and number of fallers at 12 months that were in the direction of a protective effect of treatment over time. The study concluded that The Res-Care Intervention, which maximizes physical functioning, is safe to conduct in NH residents and does not result in increased risks of falling, injury, or other adverse events.
-
|
September 15, 2010 4:00AM
Previous research has demonstrated an association between lifetime exposure to adverse events and chronic back pain (CBP), but the nature of this relationship has not been fully specified. Adversity exposure typically predicts undesirable outcomes, suggesting that lack of all adversity is optimal. However, we hypothesized that among individuals faced with CBP, a history of a low level of lifetime adversity would yield protective effects, manifested as lower impairment and healthcare utilization. Adult members of a national panel (N=396) endorsed a history of CBP when reporting their physical health status in an online survey; they further reported their functional impairment and healthcare utilization. Respondents had previously completed a survey of lifetime exposure to adverse events. Significant U-shaped quadratic relationships emerged between adversity and self-rated functional impairment (p<0.001), disabled employment status (p<0.001), frequency of physician/clinic visits for CBP (p<0.01), prescription (but not over-the-counter) analgesic use (p<0.01), and comorbid depression treatment seeking (p<0.01). Specifically, people with some lifetime adversity reported less impairment and healthcare utilization than people who had experienced either no adversity or a high level of adversity. Additional analyses failed to support alternative explanations of the findings. Implications for understanding and promoting resilience in the context of CBP are discussed.
-
|
September 7, 2010 4:00AM
Despite significant incidence and physical and mental health consequences, most college-age women do not tell anyone about experiences of interpersonal violence. Limited research explores the sociocultural context of seeking help related to violence in young women. The overall purpose of this research was to understand socially and culturally relevant factors associated with violence help seeking in college women. Eight focus groups were held with 64 participants. Narrative analysis was the primary method of analysis. Four qualitative categories emerged from the data: “Learning from one's mother”; “We're strong women; we fight”; “We didn't talk about it”; and “Where I'm from.” Findings suggest that help seeking is influenced by the messages from and experiences of mothers and extended family members. An understanding of familial and cultural determinants of help seeking is essential for relevant and effective prevention efforts.
-
|
September 3, 2010 4:00AM
Although the importance of culture in shaping individual dietary behaviors is well-documented, cultural food preferences have received limited attention in research on the neighborhood food environment. The purpose of this study was to assess the availability of commonly consumed and culturally specific fruits and vegetables in retail food stores located in majority African-American and Latino neighborhoods in southwest Chicago, IL. A cross-sectional survey of 115 stores (15% grocery stores, 85% convenience/corner stores) in African-American neighborhoods and 110 stores (45% grocery stores, 55% convenience/corner stores) in Latino neighborhoods was conducted between May and August of 2006. χ2 tests were used to assess differences in the availability (presence/ absence) of commonly consumed (n=25) and culturally specific fruits and vegetables for African Americans (n=16 varieties) and Latinos (n=18 varieties). Stores located in neighborhoods in which the majority of residents were African American or Latino were more likely to carry fresh fruits and vegetables that were culturally relevant to the dominant group. For example, grocery stores located in Latino neighborhoods were more likely to carry chayote (82.0% vs 17.6%, P<0.05), whereas grocery stores located in African-American neighborhoods were more likely to carry black-eyed peas (52.9% vs 20%, P<0.05). Most stores, however, carried fewer than 50% of commonly consumed or culturally specific fruits and vegetables. Findings from this study highlight that limited availability of culturally specific as well as commonly consumed fruits and vegetables in the neighborhood may be a barrier to fruit and vegetable consumption among African Americans and Latinos.