Pilot Intervention for Mindful Drinking and Eating for Patients on Hemodialysis with Fluid Restrictions: Lessons Learned

Patients requiring hemodialysis would benefit from evidence-based strategies that improve adherence to fluid restrictions while concurrently improving quality of life (QOL). This pilot study examined the effect of a four-week mindful drinking and eating intervention on interdialytic weight gain and QOL in patients on hemodialysis. Using paired t tests, no significant differences from pre- to post-test were found in interdialytic weight gain, a measure of fluid restriction adherence, or QOL in either the intervention (n = 18) or wait list control (n = 19) group. However, there was positive qualitative feedback from participants in exit interviews, and there were other indications of feasibility (low drop out, engagement in at-home practice according to weekly checklists). Lessons learned from this pilot study about conducting research regarding fluid restrictions for patients on hemodialysis are presented.

An Interprofessional Approach to Advance Care Planning

CONTEXT

Advance care planning (ACP) can improve patients' outcomes at end of life, and interprofessional collaboration has been recommended to facilitate ACP. However, role confusion in ACP facilitation among team members from different disciplines exists, and health professional disciplines' expectations for interprofessional collaboration in ACP are unclear.

OBJECTIVE

To review expectations of major health professional organizations for ACP competencies, in order to identify gaps and opportunities for promoting interprofessional collaboration in ACP facilitation.

METHODS

Guidelines and recommendations for ACP across disciplines including chaplaincy, medicine, nursing, psychology, and social work were identified and analyzed using content analysis. Main themes were then reviewed against national consensus statements on 4 ACP outcomes (process outcomes, action outcomes, quality of care outcomes, and healthcare outcomes) and mapped into existing domains for interprofessional education competency: values/ethics, roles/responsibilities, interprofessional communication, and teams and teamwork.

RESULTS

Three major content themes were identified: professional commitment to advocating for patients' values and self-determination, professional responsibility to facilitate ACP, and specific tasks in ACP. These themes addressed mostly process and action outcomes of ACP but not quality of care outcomes or healthcare outcomes. Few disciplines included interprofessional collaboration as part of ACP competency.

CONCLUSION

There is a need for standardized competency guidelines for interprofessional collaboration in ACP as an important first step in reducing confusion among roles and other challenges in facilitating ACP. Further efforts in practice, research, and policy are needed to facilitate interprofessional ACP, achieve competencies, and improve patients' outcomes.

Lessons learned from eight teams: The value of pilot and feasibility studies in self-management science

Designing and conducting effective intervention research is an important domain of nursing science. Nurse scientists have long recognized people with chronic conditions need effective self-management strategies across the lifespan, so they have led the way in establishing theoretical and practical grounds for the science of self-management. Guidance from pilot and feasibility research for self-management interventions is scarce. Documented exemplars of successes and failures in pilot and feasibility study designs are scant in the literature. The purpose of this paper is to illustrate methodological approaches using pilot and feasibility examples. To maximize collective lessons learned in self-management science study design, features of our pilot and feasibility research strategies that yielded both desirable and undesirable outcomes are described, analyzed, and paired with alternative solutions. A National Institute of Nursing Research P30 grant center, awarded grants to 8 pilot investigators to pilot self-management interventions. A wide variety of chronic conditions were addressed, including heart failure, chronic kidney disease, multiple sclerosis, diabetes, and HIV. The investigators provided their experiences of study implementation. Common themes across the studies were identified. There were four lessons learned from these studies: 1) maximize resources and develop enough evidence for subsequent studies; 2) embed patient-centered feasibility within implementation testing with new patient populations; 3) develop a flexible participant recruitment plan to allow for adjustments when unexpected barriers arise; and 4) define study-specific data collection procedures to demonstrate feasibility. Researchers conducting preliminary small-scale self-management intervention research must balance resources to develop and implement interventions to meet pilot and feasibility objectives.

Food Sources of Sodium in Korean Americans With Type 2 Diabetes: Implications for Cardiovascular Disease

INTRODUCTION

Excess sodium intake can increase the risk of high blood pressure and cardiovascular disease, common comorbidities for those with type 2 diabetes mellitus (T2DM). The purpose of this study is to describe sodium intake and high sodium food sources among Korean Americans (KAs) with T2DM.

METHOD

This study, a descriptive, secondary analysis of baseline data from a clinical trial for diabetes, recruited KAs with T2DM ( n = 232) from the community.

RESULTS

Average dietary sodium intake was 3,433 mg. Major sources of dietary sodium were from bicultural diets: noodles and dumplings, Korean-style soups, kimchi, breads and snacks, and boiled or seasoned vegetables. Participants who consumed excessive sodium were more likely to consume more calories and be male, married, and more recently diagnosed with T2DM.

DISCUSSION

High consumption of sodium among KAs with T2DM supports the need to develop effective, tailored interventions addressing dietary sodium that incorporates the individual's culture.

Quality of Life after Dietary Self-Management Intervention for Persons with Early Stage CKD

Dietary recommendations that potentially delay the progression of chronic kidney disease (CKD) can be perceived as restrictive and unpalatable, negatively impacting quality of life (QOL). This pilot study examined the effect of a six-week small group intervention, "Self-Management of Dietary Intake Using Mindful Eating," on QOL, health literacy, and dietary self-efficacy among persons with CKD Stages 1-3. Improvements (n=19) were found from pre-test to post-test in total scores for Kidney Disease Quality of Life Short Form-36 (p=0.003), health literacy (p=0.001), and self-efficacy (p=0.003). The intervention had promising results for improving both diet management and QOL, which supports further testing in randomized control trials.

Feasibility study of a combined lifestyle behaviors and asthma self-management intervention for school-aged children

PURPOSE

The purpose of this study is to test the feasibility of delivering an intervention that combines healthy lifestyle behaviors related to weight management with asthma self-management, the Living Healthy with Asthma intervention, to children who have asthma.

METHODS AND DESIGN

Using a mixed design, the feasibility study of the 12-week Living Healthy with Asthma intervention was conducted with a single group of children diagnosed with asthma. Pretest and posttest data were collected on asthma-related (self-management, metered dose inhaler [MDI] skill, asthma severity, quality of life [QOL]), and healthy lifestyle variables (body mass index [BMI], dietary quality). A matched comparison sample was drawn from a separate study that tested the same asthma self-management component (single intervention) used in the feasibility study to determine if the Living Healthy with Asthma intervention worked as well as the single intervention for improving children's asthma self-management.

RESULTS

Thirteen school-aged children were enrolled in the feasibility study. There were significant reductions in BMI z-scores (P = 0.007), and improvements in vegetable servings (P = 0.03), MDI skill (P = 0.005), children's QOL (P < 0.001), and parents' QOL (P = 0.03). When comparing the feasibility group with the matched comparison group (n = 13), there were no significant differences in asthma self-management, MDI skill, or asthma severity after the interventions.

PRACTICE IMPLICATIONS

Findings supported the feasibility of implementing the combined intervention, and it was not inferior to the single intervention-which supports nurses' efforts to help families manage multiple health problems.

Factors Predicting Sodium Intake of Korean Americans with Type 2 Diabetes

The increasing prevalence of type 2 diabetes mellitus (T2DM) and its complications including cardiovascular disease and chronic kidney disease threaten Korean Americans (KAs). High dietary sodium intake contributes to both conditions. The purpose of the study was to assess dietary sodium consumption and to examine the predictors of sodium intake among KA with T2DM. A total 232 KA who had uncontrolled diabetes participated in this study. The majority of the sample (69%) consumed more sodium than current national guidelines. A high level of energy intake was the strongest predictor for sodium intake with gender and marital status also related. Our findings identified predictive factors to excessive sodium intake and these data support the need for culturally-tailored education about appropriate dietary sodium and energy intake are needed for patients about T2DM.

Factors influencing dietary fat intake among black emerging adults

OBJECTIVE

To determine what factors influenced dietary fat intake (DFI) among black emerging adults.

PARTICIPANTS

Sample included 251 black emerging adults, ages 18-25 years, living in the US.

METHODS

This was a nonexperimental cross-sectional study based on self-report data.

RESULTS

The sample had high DFI. Factors related to DFI were gender (r_pb = -.22, p < .001), perceived barriers for healthy eating (r = .32, p < .001), and perceived self-efficacy (r = -.33, p < .001). These variables were also significant predictors for DFI. Gender was significantly related to DFI (b = -5.894, p = .000). Religious commitment moderated the effect of stress on DFI.

CONCLUSIONS

Gender, perceived barriers for healthy eating, and perceived self-efficacy were significant predictors for DFI. Religious commitment influenced the relationship of perceived stress and DFI. These findings may lead to interventions designed to reduce DFI and cardiovascular risks among black emerging adults.

Self-management of dietary intake using mindful eating to improve dietary intake for individuals with early stage chronic kidney disease

Using mindful eating to improve specific dietary recommendations has not been adequately studied. This feasibility study examined an intervention, self-management of dietary intake using mindful eating, with 19 participants that had mild to moderate chronic kidney disease, using a prospective, single group, pretest-posttest design. The intervention had six weekly classes focused on self-management using mindful eating, goal-setting, problem-solving, and food label reading. Weight, body mass index (BMI), 3-day 24-h dietary recalls and fasting blood samples were measured. Participants improved significantly in mean weight (203.21 ± 42.98 vs 199.91 ± 40.36 lbs; P = 0.03) and BMI (32.02 ± 5.22 vs 31.57 ± 5.27 kg/m2; P = 0.04), but not in dietary intake nor blood measures with the exception of cis-beta-carotene levels (0.020 + 0.012 vs 0.026 + 0.012 mcg/mL; P = 0.008), which correlates to fruit and vegetable servings. These promising results warrant further testing of the intervention in randomized control trials.

A Multifaceted Model to Evaluate Interprofessional Education in Clinical Nurse Specialist Programs

PURPOSE

Preparing students to engage in team-based healthcare is a major focus of clinical nurse specialist (CNS) education programs. A robust evaluation plan is needed to monitor achievement of key outcomes in this complex undertaking.

DESCRIPTION

Informed by the work of Kirkpatrick and Stufflebeam, an evaluation model that incorporates multiple information sources about process and outcomes related to interprofessional (IP) education is proposed.

OUTCOME

Improvements in scores on attitude and competency measures suggest that the program had the desired effects on students' attitudes and self-efficacy for IP collaboration and was validated by faculty clinical observations of IP communication and teamwork. Moreover, students indicated at both graduation and at 1-year follow-up surveys that they were prepared to function on IP teams, providing further evidence that the clinical nurse specialist (CNS) program prepared them in this key area of nursing practice.

CONCLUSION

The evaluation plan guided the collection of quantitative and qualitative information that faculty could use to refine the CNS program. Congruent with the CNS role as change agents, future model refinements should incorporate systems change activities.

Emotional Eating, Nonpurge Binge Eating, and Self-Efficacy in Healthy Perimenopausal Women

Purpose: To examine the relationships among nonpurge binge eating, emotional eating, and diet-related self-efficacy in perimenopausal women, a population at risk for weight gain. Design of Study: Descriptive correlational study. Method: Secondary analysis of baseline data for a weight gain prevention intervention, Mindful Restaurant Eating, with a sample of healthy perimenopausal women ( n = 43). Findings: Controlling for age and body mass index, the binge eating severity was associated with emotional eating (partial r = .71; p ≤ .01) and was negatively associated with diet-related self-efficacy (partial r = −.49; p ≤ .05). There was a significant difference ( p < .01) in emotional eating scores between women with moderate to high binge eating severity scores and those with low binge eating severity scores. Participants with higher binge eating severity also had less diet-related self-efficacy, especially with regard to resisting relapse and reducing calorie intake. Conclusions: Perhaps perceived loss of control, a central component to binge eating, negatively affects one’s ability to consistently attain dietary goals, thus affecting self-efficacy. Interventions increasing diet-related self-efficacy may prove useful in decreasing the amount of excess calories consumed because of emotional eating and/or binge eating behavior.

Relationships among maternal nutrient intake and placental biomarkers during the 1st trimester in low-income women

PURPOSE

Pre-eclampsia is a multi-system disorder caused by inadequate placentation in early pregnancy; however, little is known about the influence of nutrient intake on placental development during the crucial 1st trimester. The objective of this study was to examine the relationships between nutrient intake and the raw values and ratios of angiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng)] placental biomarkers in the 1st trimester.

METHODS

A cross-sectional study of low-income, pregnant women (n = 118). Average nutrient intake was calculated from three 24-h dietary recalls. Biomarker values were adjusted for gestational age and nutrients were adjusted for energy.

RESULTS

The angiogenic to antiangiogenic ratio [PlGF/(sFlt-1 × sEng)] was positively related to intake of vitamin D (r = 0.24), vitamin B(2) (r = 0.25), B(12) (r = 0.20), dietary folate equivalents (r = 0.19), iron (r = 0.19), and zinc (r = 0.19) and negatively related to transfats (r = -0.24). Principal component analysis revealed that a vitamin/mineral factor [t (112) = 2.58, p = 0.011] and transfats factor [t (112) = -2.03, p = 0.045] were significant predictors of the PlGF/(sFlt-1 × sEng) ratio. The vitamin and mineral factor was a significant predictor of sFlt-1 [t (122) = 2.29, p = 0.024].

CONCLUSIONS

Expression of placental biomarkers in the early weeks of pregnancy may be influenced by intake of nutrients. Understanding the influence of maternal nutrient intake and placental development in the 1st trimester may provide the opportunity to avert the development or blunt the severity of preeclampsia.

The effect of a mindful restaurant eating intervention on weight management in women

OBJECTIVE

To evaluate the effect of a Mindful Restaurant Eating intervention on weight management.

DESIGN

Randomized control trial.

SETTING

Greater metropolitan area of Austin, Texas.

PARTICIPANTS

Women (n = 35) 40-59 years old who eat out at least 3 times per week.

INTERVENTION

The intervention, using 6 weekly 2-hour, small group sessions, focused on reducing calorie and fat intake when eating out through education, behavior change strategies, and mindful eating meditations.

MAIN OUTCOME MEASURES

Weight, waist circumference, self-reported daily calorie and fat intake, self-reported calories and fat consumed when eating out, emotional eating, diet related self-efficacy, and barriers to weight management when eating out.

ANALYSIS

General linear models examined change from baseline to final endpoint to determine differences in outcomes between the intervention and control group.

RESULTS

Participants in the intervention group lost significantly more weight (P =.03), had lower average daily caloric (P = .002) and fat intake (P = .001), had increased diet-related self-efficacy (P = .02), and had fewer barriers to weight management when eating out (P = .001).

CONCLUSIONS AND IMPLICATIONS

Mindful Restaurant Eating intervention was effective in promoting weight management in perimenopausal women.

Eating at fast-food restaurants and dietary quality in low-income pregnant women

Little is known about how fast-food consumption affects dietary quality in women during the first trimester of pregnancy, which may adversely affect pregnancy outcomes. An observational design compared high versus low frequency of fast-food consumption in low-income pregnant women (N = 50) during the first trimester. Although high-frequency fast-food consumers ate significantly more vegetables, they also consumed more gravies, less fruit, and more daily calories, with a higher percentage of total calories from fats. Those with high-frequency fast-food consumption were more likely to be obese, depressed, and stressed and they skipped more meals. In addition, the combination of depression, stress, and emotional eating depression and anxiety subscale scores explained 45% of the variance in dietary quality. High frequency of fast-food consumption contributed to poor dietary quality and excessive caloric intake, which may lead to excessive gestational weight gain.

Strategies for and barriers to managing weight when eating at restaurants

INTRODUCTION

Eating in restaurants contributes to excess caloric intake, which leads to weight gain, but little is known about strategies used to manage weight or barriers to weight management in restaurant settings. We describe and compare the strategies men and women use and the barriers they encounter when eating at restaurants.

METHODS

We recruited a convenience sample of 146 adults at a university open house. Participants completed questionnaires on demographics and eating patterns, strategies used to manage weight in restaurants, and barriers to managing weight in restaurants.

RESULTS

The most common strategies used by participants were avoiding sugar-filled drinks, choosing steamed vegetables and whole-grain foods, and stopping eating when full. We found few differences by sex: women were more likely to share appetizers or meals, substitute appetizers for meals, have salads as entrées, order salad dressing on the side, and bring half of the meal home.

CONCLUSION

Women and men had more similarities than differences in strategies for and barriers to managing weight in restaurants. We need to understand what influences food choices at restaurants in order to develop comprehensive plans for weight management.

Anatomy of a binge: food environment and characteristics of nonpurge binge episodes

This secondary analysis prospectively examined nonpurge binge eating patterns in a naturalistic setting in 48 nonpurge binge eating women. Binge eating episodes were analyzed from 14-day food diaries to describe the binge and to determine how types of foods consumed and setting variables affected nonpurge binge eating women. Findings indicated that binge episodes occurred mostly during the lunch (27.1%) and dinner hours (45.8%) and on weekends (62.5%). Half of the binge episodes occurred in restaurants. The most common items consumed during binges were breads/pasta (64.6%), sweets (56.2%), high fat meat items (45.3%), and salty snacks (39.6%) while the predominant foods consumed during these binges were high fat meat items (29.2%), sweets (21.0%), and salty snacks (18.8%). Those who predominantly binged on sweets had significantly more binge days [t(46)=-2.8, p<.01]. Women who predominantly binged on fried meat had significantly higher body mass index (BMI) [t(46)=-2.8, p<.01]. A higher BMI was also associated with binging during meals rather than binging during snacks [t(46)=2.4, p<.05]. The results suggest that nonpurge binge eating patterns are more problematic during meal times.

Addressing barriers to health promotion in underserved women

Underserved women face numerous barriers to adopting healthy eating behaviors. To develop effective health-promotion interventions for underserved women, barriers specific to the individual need should be addressed. Influenced by individual characteristics, experiences, and culture, different types of barriers (internal, interpersonal, and environmental) can overlap to impede healthy eating in underserved women. On the basis of literature review and qualitative research experiences with underserved women, 4 potential approaches for addressing barriers to health promotion were identified: (1) individualizing interventions; (2) developing collaborative partnerships within the community; (3) using positive deviance inquiry to build on community assets; and (4) changing public policy.

Restaurant eating in nonpurge binge-eating women

This study describes restaurant-eating behaviors for nonpurge binge-eating women in comparison to dieters. Restaurant-eating behaviors were determined from a content analysis of 14-day food diaries using a convenience sample of 71 women who reported binging without purging and 46 dieters without a recent binge history. Comparing bingers to dieters, there were no significant differences in frequency of eating out, dessert consumption at restaurants, or fast food eating. Bingers more often perceived restaurant eating to be uncontrolled and excessive. Both bingers and dieters consumed significantly more calories (226-253 kcal) and fat (10.4-16.0 gm) on restaurant days. Extra calories consumed on restaurant-eating days may contribute to weight gain over time, especially with frequent restaurant eating. Restaurants may present a high-risk food environment for bingers and dieters, contributing to loss of control and excess consumption.

Trajectory of weight changes in the first 6 weeks postpartum

OBJECTIVE

To determine the trajectory of postpartum weight changes and to examine associations between weight change in the first 6 weeks postpartum and demographic, clinical, psychosocial, and behavioral variables.

DESIGN

Prospective, longitudinal design.

SETTING

Community hospital and university research setting.

PARTICIPANTS

26 low-income women (9 White, 8 Black, and 9 Hispanic) with uncomplicated term pregnancies.

MAIN OUTCOME MEASURE

Body mass index measured weekly.

RESULTS

Among White women, body mass index decreased significantly for the first 3 weeks of the postpartum period. Black women experienced a significant reduction in body mass index for only the first 2 postpartum weeks. Similarly, the postpartum body mass index decreased for the first 2 weeks for Hispanic women. Prepregnancy body mass index and gestational weight gain each had a significant positive effect on postpartum body mass index. Perception of social support at 4 weeks had a significant positive effect on postpartum body mass index in Black women.

CONCLUSIONS

The trajectory of weight change was nonlinear with large initial weight losses during the first 2 to 3 weeks postpartum followed by weight plateaus for the remainder of the first 6 weeks postpartum.

Developing a Course to Teach Spanish for Health Care Professionals

To make the baccalaureate nursing curriculum more responsive to changing U.S. demographics, the School of Nursing at The University of Texas at Austin instituted a required course, titled Spanish for Health Care Professionals. This course, developed in collaboration with the University's Department of Spanish and Portuguese, focuses on conversational Spanish using the communicative language teaching approach, rather than grammar and medical terminology instruction. Class activities, along with course materials, are linked to nursing practice. Course assignments are designed to develop authentic communication in reading, writing, listening, speaking, and understanding culture, and students demonstrated oral and written linguistic gains in relation to their Spanish fluency and accuracy. Because the Hispanic population is now the largest minority group in the United States, this course will help nurses communicate with Spanish-speaking patients.

Retention of Pregnancy-Related Weight in the Early Postpartum Period: Implications for Women’s Health Services

OBJECTIVE

To examine the proportion of women who reached their prepregnant weight at 6 weeks postpartum and the average amount of weight retained or lost by this time; to determine predictors of early (6 week) postpartum weight retention; and to propose related implications for women's health care and services.

DATA SOURCES

The literature review was based on a search of Medline for the years 1986 to 2004 using the keywords postpartum weight with inclusion of additional articles known to the authors that did not appear in the electronic search.

STUDY SELECTION

The resulting 83 articles were scrutinized to identify those that reported data on weight retention at 6 weeks postpartum (range, delivery to 3 months) and associated anthropometric, social, obstetric, or behavioral predictors. A total of 12 articles met inclusion criteria for the review.

DATA EXTRACTION

Data were extracted related to the proportion of women achieving their postpartum weight at 6 weeks postpartum, the amount of weight retained or lost up to 6 weeks postpartum, and predictors of amount of weight retained or lost.

DATA SYNTHESIS

On average, at 6 weeks postpartum, women retain 3 to 7 kg of the weight gained during pregnancy, with at least two thirds exceeding their prepregnant weights. Gestational weight gain is the most significant predictor of weight retention.

CONCLUSIONS

Women vulnerable to obesity and weight gain need weight-related health care and improved access to such care to promote weight loss after 6 weeks postpartum.

Weight and behavioral and psychosocial factors among ethnically diverse, low-income women after childbirth: II. Trends and correlates

OBJECTIVE

This paper presents a longitudinal analysis of behavioral and psychosocial correlates of weight trends during the first postpartum year. Data are derived from the Austin New Mothers Study (ANMS), a longitudinal study of a low-income, tri-ethnic sample of postpartum women that incorporated serial assessment of weight and behavioral and psychosocial variables.

METHOD

Postpartum body mass index (BMI) was measured prospectively (post-delivery, 6 weeks, and 3, 6, and 12 months postpartum). The analytic sample consisted of 382 White, African American, and Hispanic women receiving maternity care funded by Medicaid who had at least three measured postpartum weights. Behavioral and psychosocial variables included energy intakes, fat intakes, physical activity, health related lifestyle, smoking, breastfeeding, contraception, depressive symptoms, emotional eating, body image, and weight-related distress.

RESULTS

Using hierarchical linear modeling to incorporate baseline only and time-varying effects, significant associations with postpartum BMI were found for the following variables: ethnicity (p = .001), time of weight measurement (p < .001), the interaction of ethnicity and time (p = .005), pre-pregnant BMI (p < .001), gestational weight gain (p < .001), weight-related distress (p < .001), and energy intakes (p = .005). After adjusting for covariates, ethnic groups displayed differing trends in postpartum BMI resulting in White women having significantly lower BMIs at 12 months postpartum compared to ethnic minority women (p's < .01).

CONCLUSION

Behavioral and psychosocial variables contribute to a fuller understanding of BMI status of low-income women during the first postpartum year.

Weight and behavioral and psychosocial factors among ethnically diverse, low-income women after childbirth: I. Methods and context

OBJECTIVE

In this paper, we present the background, hypotheses, methods, and descriptive findings from the Austin New Mothers Study, a longitudinal series measuring weight and contextual variables across the first postpartum year. Among the distinguishing features of this study are its tri-ethnic sample of low-income women and its serial measurement of the behavioral and psychosocial context of postpartum weight changes post-delivery and at 6 weeks, and 3, 6, and 12 months postpartum.

METHOD

A prospective longitudinal design was used to assess body mass index (BMI), energy intake, fat intake, physical activity, health-related lifestyle, depressive symptoms, body image, and weight-related distress at each observation.

SAMPLE

The analytic sample consisted of 382 White, African American, and Hispanic women.

FINDINGS

For BMI, effects for ethnicity (p < .001), time (p < .001), and their interaction (p = .005) were significant. All ethnic groups had significant declines in BMI from delivery to 6 weeks postpartum. Thereafter, BMIs of White women declined during the second 6 months, whereas those of Hispanic and African American women either displayed small gains or plateaus between adjacent observations. Time-related effects were significant for behavioral and psychosocial variables except for body image and weight-related distress, whereas effects for ethnicity were significant on fat intake, depressive symptoms, and body image. Despite declines in depressive symptoms, women remained at risk of depression across the first postpartum year.

CONCLUSIONS

Low-income ethnic minority women have a higher vulnerability to postpartum weight gains or plateaus. High depressive symptoms occurred in all ethnic groups examined.

Do low-income women attain their pre-pregnant weight by the 6th week of postpartum?

OBJECTIVES

To assess the proportion of women attaining pre-pregnant weight, and to ascertain the predictors of amount of retained weight at 6 weeks postpartum, in a tri-ethnic sample of low-income women.

DESIGN

Short-term longitudinal design from post-delivery to 6 weeks postpartum.

PARTICIPANTS

419 African-American, Hispanic, and White women receiving perinatal care funded by Medicaid.

MAIN OUTCOME VARIABLES

Proportion of women attaining pre-pregnant weight at 6 weeks postpartum; the amount of weight retained at 6 weeks postpartum.

RESULTS

Fifteen percent of women attained their pre-pregnant weight at 6 weeks postpartum. In multiple regression analysis, maternal weight gain during pregnancy was the predominant predictor (B=.88, SE=.02, P=.000). Hispanic ethnicity (B=.69, SE=.33, P=.039) and the interaction between maternal weight gain and gestational length (B=-.04, SE=.02, P=.032) made small, independent contributions to amount of retained weight at 6 weeks postpartum. The interaction of ethnicity and maternal age predicted 1.3% of the variance in retained weight, but this was not significant. Health practices were not associated significantly with the amount of weight retained at 6 weeks postpartum.

CONCLUSIONS

The majority of women did not return to their pre-pregnant weight by 6 weeks postpartum. The amount of retained weight after delivery is largely influenced by prenatal maternal weight gain.

Dieting, perceived deprivation, and preoccupation with food

A prospective study using 14-day food diaries was conducted to determine whether perceived deprivation and preoccupation with food correspond to actual caloric and fat intake, using a sample of 121 adult women who were binge eating without purging or were currently dieting. Caloric and fat intake were not significantly related to perceived deprivation. Only weight cycling and Revised Restraint Scale was significantly correlated with perceived deprivation with 11% of the variation explained by the Revised Restraint Scale scores. These findings support the contention that psychological deprivation occurs regardless of caloric intake. For preoccupation with food, only fat intake and Revised Restraint Scale scores were significantly correlated with 15% of the variance explained by the Revised Restraint Scale scores.

The use of individualized goal setting to facilitate behavior change in women with multiple sclerosis

Setting goals is a useful strategy for changing behavior. The purpose of this study was to examine the effectiveness of a wellness intervention for women with multiple sclerosis (MS) on achieving health-related goals set individually by each participant in the experimental group (N = 57) using goal attainment scaling. The two-phase intervention included lifestyle-change classes over 8 weeks, then telephone follow-up over 3 months. Participants were followed over an 8-month period. Goal achievement was assessed at baseline, 2 months (following class), 3 1/2 months (6 weeks after class), 5 months (following 3 months of telephone follow-up), and at 8 months. The majority of the women met or exceeded all their individualized goals for changing behavior at the 6-week postclass assessment. Achievement and maintenance of individual goals remained high (59%-84%) over the 5 months after class follow-ups. These data support the positive effects of wellness interventions for helping women with MS to meet their own individualized health goals. Setting goals with incremental steps helped participants to articulate their individual goals and monitor achievement over time.

Relationships between body image and depressive symptoms during postpartum in ethnically diverse, low income women

The aim of this study was to examine body image, depressive symptoms, and their interrelationship at post-delivery and at 6 weeks postpartum in a triethnic sample of low income new mothers. Data for this study were drawn from the Austin New Mothers Study. Participants were 76 Anglo/White, 72 African American, and 135 Hispanic new mothers who were participating in Medicaid, at least 18 years old, free of medical risk factors, and delivered at term. Body image was measured by the Body Cathexis Scale (BCS) and depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D). The leading areas of body dissatisfaction in postpartum were similar across ethnic groups. At 6 weeks postpartum Anglo women had the highest number of body image components perceived negatively, whereas African-American women had the least. In the overall sample, body image attitudes were significantly related to depressive symptoms in correlational (r's .19 to .34) and regression analyses. In addition, African American ethnicity was associated in regression analyses with higher depressive symptoms. Neither African American nor Hispanic ethnicity significantly moderated the relationship between body image attitudes and depressive symptoms in tests of interactions. Marital/partnered status and income level were related to depressive symptoms at both time points. In addition, being a woman with a parity of II was associated with higher depressive symptoms at 6 weeks postpartum. Although addition of these personal variables increased the percent of variance accounted for, body image attitudes continued to be significant predictors of depressive symptoms.

The relationship between basic need satisfaction and emotional eating

Eating in response to emotions may lead to the consumption of excessive calories which typically leads to weight gain. This study examined the relationship between basic need satisfaction as identified by Maslow's hierarchy and emotional eating. According to Modeling and Role-Modeling theory, when lack of basic need satisfaction functions as a stressor, individuals may be more likely to engage in emotional eating as a substitute for fulfilling their needs in order to maintain homeostasis. The Basic Need Satisfaction Inventory (BNSI) had a strong, negative correlation (r = -.49; p < .001) to the Emotional Eating Scale (EES) indicating that the lower the level of basic need satisfaction, the more likely one engaged in emotional eating. In predicting EES score, 27.7% of the variance was explained by the self-esteem subscale of BNSI. This study supports looking at underlying issues contributing to weight gain in order to develop effective interventions for weight management.

Weight management practices among primary care providers

This pilot study examined how primary care providers manage patients with weight problems, an important component of primary care. A convenience sample of 17 nurse practitioners and 15 physicians were surveyed about assessments and interventions used in practice for weight management along with perceived barriers to providing effective weight management. Practice patterns between gender, profession and practice setting of the nurse practitioners were compared.

Using a women's health perspective to guide decisions made in quantitative research

Women's health, as an emerging area of nursing scholarship, is based on a set of philosophical assumptions. These assumptions are: (i) women's health can best be understood by examining women's lived experiences within a specific context; (ii) gender bias must be avoided; (iii) the focus should be on health rather than illness; and (iv) non-exploitative relationships should be established between the researcher and research participants. Assumptions from a women's health perspective can be used by researchers to guide decisions made in conducting research with women. In order to strengthen the correspondent validity (i.e., the fit between theory and methods), research decisions need to be consistent with the philosophical assumptions of the inquiry. Examples of quantitative research decisions influenced by a women's health perspective are illustrated using a study of binge eating in women.

Using self-care strategies to make lifestyle changes

Self-care in health promotion includes developing the skills needed to devise, implement, evaluate, and revise an individualized plan for lifestyle change. Using content analysis, this study examined the strategies chosen by participants (N = 95) to initiate a lifestyle change, as well as the barriers they identified to change. Goal achievement and effectiveness of the strategies chosen were evaluated at 5 and 10 weeks. Using self-care strategies to make lifestyle changes, 42.1% had achieved their goal and 49.5% had partly achieved their goal by Week 10. Social support, tailoring strategies, self-monitoring, medication, and cue restriction were considered the most effective strategies. Being able to individualize the strategies was most important to goal achievement, followed by having a specific goal, planning for barriers, and being able to make revisions.

Eating patterns in women with multiple sclerosis

For persons with multiple sclerosis (MS), good nutrition has the potential to enhance quality of life and reduce the risk of lifestyle diseases and secondary conditions. The purpose of this study was to describe nutritional intake of women with MS and to determine what factors influenced their intake. Based on 3-day food diary data, participants had an inadequate intake (< 10% lower than recommended) of carbohydrates, dietary fiber, vitamin E, calcium and zinc. In contrast, they consumed saturated fat, protein, vitamin A, vitamin C, folate and iron at higher levels than recommended. Age was significantly related to nutritional intake with older women consuming fewer calories, total fat and saturated fat. Despite evidence supporting the importance of following recommended nutritional guidelines, nutritional intake for participants in this study was not optimum in many important areas. This study supports the need for interventions to promote good nutrition among persons with MS.

Caloric intake patterns of nonpurge binge-eating women

Daily caloric intake of nonpurge binge-eating women was monitored over 28 days using food diaries to determine how caloric intake patterns were related to binge eating. The majority of participants had extreme fluctuations in daily caloric intake. Caloric intake for both nonbinge days and days preceding the highest-calorie binge days was significantly lower than caloric intake on binge days and highest-calorie binge days. The lower caloric intake was not low enough to cause physiological deprivation. Although there was not physiological deprivation of calories, the individual may have felt that she ate less than desired, which may have contributed to subsequent binge eating.

The relationship between binge eating severity and body fat in nonpurge binge eating women

The relationship between binge eating severity, measured by caloric intake, and amount of body fat, measured by percent of body fat and body mass index (BMI) was examined in nonpurge binge eating women. Although there was a low, but significant, relationship between binge eating severity and BMI, the relationship was not significant between binge eating severity and percent of body fat. Age and weight cycling were the best predictors for percent of body fat, while weight cycling alone was the best predictor for BMI. It cannot be assumed that caloric intake during binge eating is the central cause of obesity in nonpurge binge eating women.

Linkage analysis of er-1, a recessive Pisum sativum gene for resistance to powdery mildew fungus (Erysiphe pisi D.C.)

Linkage analysis was used to determine the genetic map location of er-1, a recessive gene conditioning resistance to powdery mildew, on the Pisum sativum genome. Genetic linkage was demonstrated between er-1 and linkage group 6 markers after analyzing the progeny of two crosses, an F2 population and a set of recombinant inbred lines. The classes of genetic markers surrounding er-1 include RFLP, RAPD and allozyme markers as well as the morphological marker Gty. A RAPD marker tightly linked to er-1 was identified by bulked segregant analysis. After DNA sequence characterization, specific PCR primers were designed to convert this RAPD marker into a sequence characterized amplified region (SCAR).

Characterisation of progeny from backcrosses of triploid hybrids between Hordeum vulgare L. (2x) and H. bulbosum L (4x) to H. vulgare

Interspecific hybridisations between Hordeum vulgare L. (cultivated barley) and H. bulbosum L. (bulbous barley grass) have been carried out to transfer desirable traits, such as disease resistance, from the wild species into barley. In this paper we report the results of an extensive backcrossing programme of triploid hybrids (H. vulgare 2x x H. bulbosum 4x) to two cultivars of H. vulgare. Progenies were characterised cytologically and by restriction fragment length polymorphism analysis and comprised (1) haploid and diploid H. vulgare plants, (2) hybrids and aneuploids, (3) single and double monosomic substitutions of H. bulbosum chromosomes into H. vulgare and (4) chromosomal rearrangements and recombinants. Five out of the seven possible single monosomic chromosome substitutions have now been identified amongst backcross progeny and will be valuable for directed gene introgression and genome homoeology studies. The presence amongst progeny of 1 plant with an H. vulgare-H. bulbosum translocated chromosome and one recombinant indicates the value of fertile triploid hybrids for interspecific gene introgression.

Linkage mapping of sbm-1, a gene conferring resistance to pea seed-borne mosaic virus, using molecular markers in Pisum sativum

The location of sbm-1 on the Pisum sativum genetic map was determined by linkage analysis with eight syntenic molecular markers. Analysis of the progeny of two crosses confirmed that sbm-1 is on chromosome 6 and permitted a more detailed map of this chromosome to be constructed. The inclusion of Fed-1 and Prx-3 among the markers facilitated the comparison of our map with the classical genetic map of pea. The sbm-1 gene is most closely linked to RFLP marker GS185, being separated by a distance of about 8 cM. To determine the practical value of GS185 as a marker for sbm-1 in plant breeding programs, the GS185 hybridization pattern and virus-resistance phenotype were compared in of a collection of breeding lines and cultivars. Three GS185 hybridization patterns were discerned among the lines. A strong association was found between one of these patterns and resistance to PSbMV.

A concept analysis of intimacy

This concept analysis examines how the concept of intimacy has been defined in the scholarly literature in order to determine what characteristics or necessary conditions exist that differentiate this phenomenon from all other phenomena. The objective of this concept analysis is to derive a theoretical definition of intimacy that can then be used to operationalize the concept for research. Intimacy is of significance to psychiatric nursing theory because (a) intimacy has been identified as being important to the psychosocial development of adults; (b) intimacy plays a developmental role in identity formation, through the consensual validation of personal worth by providing individuals with the opportunity to feel understood and accepted as they are, within the relationship; (c) research indicates that married couples reporting a deficiency or an absence of intimacy have a significantly higher proportion of symptoms of a nonpsychotic emotional illness; (d) failure to develop intimacy in relationships has been identified as one of the most common factors for seeking outpatient psychotherapy; and (e) intimacy has been identified as a key component in individuals' satisfaction with their social support. The theoretical definition for intimacy is this: a quality of a relationship in which the individuals must have reciprocal feelings of trust and emotional closeness toward each other and are able to openly communicate thoughts and feelings with each other. The conditions that must be met for intimacy to occur include reciprocity of trust, emotional closeness, and self-disclosure. As the literature does not uniformly incorporate physical intimacy as a necessary condition for the concept of intimacy, physical closeness was not incorporated into the definition.

Nucleotide sequence of the coat protein gene of pea seed-borne mosaic potyvirus

The nucleotide sequence of a 1355 bp cDNA representing the 3'-terminal sequences of pea seed-borne mosaic virus (PSbMV) was determined. This sequence contained a single long open reading frame (ORF) of 1189 bp ending with a single TAA termination codon. Downstream from the ORF was an untranslatable region of 189 bp followed by eight bp of polyadenylate. The probable location of the PSbMV coat protein codons within the long ORF was determined by comparing the inferred amino acid sequence with other potyviral coat protein sequences and by examining the sequence for a potyviral polyprotein cleavage cassette sequence. Direct chemical sequencing of the PSbMV coat protein revealed it to be blocked at its amino terminus. A partial amino acid sequence representing the N terminus of the protease-resistant core of the coat protein was determined, however. Alignment of the PSbMV coat protein sequence and the sequences of seven other potyviral coat proteins revealed significant homology, ranging from 53.7% for potato virus Y strain D to 43.2% for tobacco vein mottling virus.

Nucleotide sequence of the coat protein gene of a necrotic strain of potato virus Y from New Zealand

The sequence of the 3'-terminal 1,134 nucleotides of the genome of a New Zealand isolate of a necrotic strain of potato virus Y (PVYN) has been determined. This sequence contains one large open reading frame of 796 nucleotides, the start of which was not identified, which is capable of encoding a protein of 264 amino acid residues with a molecular weight of 29,631. Comparison of the amino acid sequence with a published coat protein sequence of another strain, PVY-D, and with the amino acid sequence deduced from PeMV cDNA sequence data, confirms that the 3' cistron encodes the viral coat protein in PVYN. Adjacent to the 3' end of the coding region there is an untranslatable sequence of 326 nucleotides terminating in a polyadenylate tract. An alignment of the PVYN amino acid sequence with the coat protein sequences of six other potyviruses revealed significant sequence similarities in the internal and carboxy terminal regions. Much amino acid sequence similarity was found between PVYN, PVY-D, and PeMV (91-93%), suggesting that PeMV should be regarded as a PVY strain. An analysis of the 3'-untranslated region of the six potyviruse revealed PVYN and PeMV as the only viruses displaying sequence similarity in this region. The 3'-untranslated sequences of PVYN and PeMV were further examined for secondary structure.