Enhancing family experience in the paediatric intensive care unit through the adoption of the family care journal: A single-center study

BACKGROUND

Multidisciplinary patient care rounds are increasingly seen as a vital complement to patient care management. Family engagement in these rounds, especially in the paediatric population, is important to treatment and outcomes, but there is little information about family experience in the Paediatric Intensive Care Unit (PICU).

AIMS

To develop a process using family care journals (FCJ) to systematically evaluate family experience in the PICU and identify needed supportive resources that will enhance their critical care stay.

METHODS

This is a single-centre quasi-experimental design conducted at a large urban quaternary level freestanding children's hospital. A family care journal (FCJ) was distributed to families upon admission to PICU to serve as a resource tool during their stay. An electronic point of care (POC) questionnaire was used to assess families' experiences in the PICU.

RESULTS

Three hundred sixty-six questionnaires were completed (100% response rate) and analysed. Overall, there was an improvement in all phases post FCJ implementation compared with the baseline. Seventy five percent of families found it a useful tool for communication with the PICU team. Open-ended comments revealed improvement opportunities related to communication, environment, and delay in care. Almost all commented on excellent nursing care.

CONCLUSIONS

Introducing FCJ in a paediatric ICU is a practical approach, providing a cost-effective method to assess family experiences and gain insights for ongoing quality improvement efforts. Collaboration among all care team members, including nursing, medical, and administrative leaders, is crucial for empathetically addressing parental needs during hospitalization.

RELEVANCE TO CLINICAL PRACTICE

Combining the use of journals and questionnaires provides the clinical team with an efficient means of collecting valuable feedback from parents regarding their experience in the PICU and the factors that foster ongoing commitment from families. Nurses play a crucial role in encouraging the adoption of these journals, as they promote greater parent involvement in their children's care.

'There is nothing less spectacular than a pestilence': Picturing the pandemic in Mass Observation's COVID-19 collections

What is to be gained by studying visual observation in Mass Observation's COVID-19 collections? What can we see of the pandemic through diarists' images and words? Visual methods were part of the plural research strategies of social research organisation Mass Observation (MO) in its first phase, when it was established in 1937, but remained marginal in relation to textual research methods. This continues with the post-1981 revival of the Mass Observation Project (MOP), with its emphasis on life writing. With wider shifts in technology and accessibility, however, even when they are not solicited, photographs now accompany MOP correspondents' submissions. In MO's substantial COVID-19 collections, images appear in or as diary entries across a range of forms, including hand-drawn illustrations, correspondent-generated photographs, creative photomontages, and screengrabs of memes. In addition, diarists offer textual reflections on COVID-19's image cultures, such as the role of photographs in pandemic news media, as well as considering how the pandemic is intersecting with the visual in more abstract ways, from themes of surveillance and 'Staying Alert' in public health messaging to internal pictorial imaginaries produced as a result of isolation and contemplation. Positioning these materials in relation to wider patterns in pandemic visual culture, including public photographic collecting projects that make explicit reference to MO as their inspiration, this article considers the contribution of the visual submissions and image-rich writing in MO's COVID-19 collections to the depiction of a virus commonly characterised as invisible.

Archiving the COVID-19 pandemic in Mass Observation and Middletown

The COVID-19 pandemic generated debates about how pandemics should be known. There was much discussion of what role the human sciences could play in knowing - and governing - the pandemic. In this article, we focus on attempts to know the pandemic through diaries, other biographical writing, and related forms like mass photography. In particular, we focus on the archiving of such forms by Mass Observation in the UK and the Everyday Life in Middletown (EDLM) project in the USA, and initial analyses of such material by scholars from across the human sciences. Our main argument is that archiving the pandemic was informed by, and needs viewing through, the history of the human sciences - including the distinctive histories and human sciences of Mass Observation and Middletown. The article finishes by introducing a Special Section that engages with archiving the pandemic in two senses: the archiving of diaries and related forms by Mass Observation and the EDLM project, and the archiving of initial encounters between researchers and this material by History of the Human Sciences. The Special Section seeks to know the pandemic from the human sciences in the present and to archive knowing the pandemic from the human sciences for the future.

Can we call Anne Lister a lesbian?

The introductions of scholarly works on queer desire between eighteenth- and nineteenth-century British women typically pose some version of the question "do they count as lesbians?" Historians and literary critics have responded with a variety of answers; while some embrace the term "lesbian" despite the anachronism, others hesitate, using words like "Sapphic" or longer phrases like "women who loved women" to characterize the object of study. Indeed, in the absence of a noun or a recognized social role for women who loved other women before the twentieth century, the ways such women conceptualized themselves necessarily diverge from modern lesbian identity. But although the hesitation to use modern terminology makes sense in the case of many women, I argue in this paper that Anne Lister (1791-1840) is an exception. From her own descriptions in her extensive diaries, it is clear that Lister's thoughts, feelings, and actions are largely consistent with modern lesbian identity-particularly given that "modern lesbian identity" is not a monolith. I support this contention by examining evidence from the journals themselves as well as by considering recent arguments that focus on the fluidity and capaciousness of terminology itself. Finally, I suggest that applying the word "lesbian" to Lister is a strategic way to communicate the extent of her relationships with women to a public that still sometimes refuses to admit that such relationships existed in the past.

Co-production for or against the university: student loneliness and the commodification of impact in Covid-19

PURPOSE

This paper explores the dissonance between co-production and expectations of impact in a research project on student loneliness over the 2019/2020 academic year. Specific characteristics of the project - the subject matter, interpolation of a global respiratory pandemic, informal systems of care that arose among students, and role of the university in providing the context and funding for the research - brought co-production into heightened tension with the instrumentalisation of project outputs.

STUDY DESIGN/METHODOLOGY/APPROACH

Our project consisted of a series of workshops, research meetings, and mixed-methods online journalling between 2019-2020. This paper is primarily a critical reflection on that research, based on observations by and conversations between the authors, together with discourse analysis of research data.

FINDINGS

We argue that co-producing research with students on university contexts elevates existing tensions between co-production and institutional valuations of impact; that co-production with students who had experienced loneliness made necessary space for otherwise absent support and care; that our responsibility to advocate for our evidence and co-researchers came into friction with how the university felt our research could be useful; and that each of these converging considerations are interconnected symptoms of the ongoing marketisation of HE.

ORIGINALITY/VALUE

This paper provides a novel analysis of co-production, impact, and higher education in the context of an original research project with specific challenges and constraints. It is a valuable contribution to methodological literatures on co-production, multidisciplinary research into student loneliness, and reflexive work on the difficult uses of evidence in university contexts.

'I'm Gonna Tell You about How Mrs Rona Has Affected Me'. Exploring Young People's Experiences of the COVID-19 Pandemic in North East England: A Qualitative Diary-Based Study

Children and young people risk being 'disproportionately harmed' by the COVID-19 pandemic. Whilst an evolving body of literature focuses on the impact of the pandemic on the mental health and wellbeing of children and young people, less attention has been paid to the collection of qualitative, exploratory data. The aim of this study was to examine young people in North East England's experiences of COVID-19 and associated control measures. Flexible, qualitative diaries were collected with 31 young people aged 13-17 for six weeks between July and October 2020. Diary extracts were curated using Instagram Direct Messaging (DM), email and text messaging. At the end of this study, participants took part in a follow-up interview (conducted by telephone or Zoom), asking them to reflect on their diary entries. Thematic analysis of diaries and interviews yielded three central themes: (1) impacts upon mental health and emotional wellbeing; (2) disruptions and changes to education and school life; and (3) frustration, burden and responsibility. These findings highlight acute mental health impacts (loneliness, isolation, anxiety) as well as longer-term repercussions from disrupted education (missed parts of curriculum, home schooling, cancelled exams, periods of isolation) on young people aged 13-17 as a result of the COVID-19 pandemic.

Pandemic and Social Work: Exploring Finnish Social Workers’ Experiences through a SWOT Analysis

This article addresses the experiences of Finnish frontline social workers during the first wave of the COVID-19 pandemic in the spring of 2020. Two questions are addressed. First, ‘what types of challenges social work professionals faced’ in their everyday, ‘glocal’ pandemic setting and, second, what types of solutions they developed to meet these challenges. The data consist of 33 personal diaries that social work professionals created from mid-March to the end of May 2020. The diaries are analysed by a thematic content analysis and placed within the framework of a strengths, weaknesses, opportunities and threats analysis. The results suggest that the pandemic challenged social work at all levels, from face-to-face interactions to its global relations. The pandemic revealed not only the number of existing problems of social work, but also created new types of challenges. It demanded ultimate resilience from social workers and a new type of adaptive governance from social welfare institutions.

A phenomenological-hermeneutic study exploring caring responsibility for a chronically ill, older parent with frailty

Aim

To provide lifeworld insights into experiences of adult children with caring responsibility for an 80+-year-old chronically ill parent with frailty.

Background

Informal care is common in Nordic welfare countries; however, little is known about adult children's experience of caring responsibility in this setting.

Design

A phenomenological-hermeneutic study based on Reflective Lifeworld Research.

Methods

Diaries and semi-structured interviews with 12 adult children.

Results

Caring responsibility is identified as "a condition of life, filled with uncertainty." Three constituents contribute to this phenomenon: (a) balancing love, duty and reciprocity; (b) being the parent's advocate and manager; and (c) experiencing concerns and bodily strain.

Conclusion

Adult children work hard to provide care and enhance the well-being of their parent. Heidegger's concept 'Fürsorge' may help us understand how by showing how caring responsibility means balancing different roles vis-à-vis the parent, one's own life and the health and social systems. Caring responsibility changes the relationship between parent and child.

The prominent role of informal medicine vendors despite health insurance: a weekly diaries study in rural Nigeria

In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare providers and the factors associated with provider choice by insurance status in rural Nigeria. We analysed year-long weekly health diaries on illnesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsidized health insurance programme. The weekly diaries capture not only catastrophic events but also less severe events that are likely underreported in surveys with longer recall periods. Individuals had insurance coverage during 34% of the 1761 reported health episodes, and they consulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression analyses showed that insurance coverage was associated with significantly higher utilization of formal health care: individuals consulted upgraded insurance programme facilities in 20% of insured episodes compared with 3% of uninsured episodes. Nonetheless, regardless of insurance status, most consultations involved an informal provider visit, with informal providers encompassing 73 and 78% of all consultations among insured and uninsured episodes, respectively, and individuals spending 54% of total annual out-of-pocket health expenditures at such providers. Given the high frequency at which individuals consult informal providers, their position within both the primary healthcare system and health insurance schemes should be reconsidered to reach universal health coverage.

A caring science study of creative writing and human becoming

The previous research describes creative writing to have a potential for self-care and healing in relation to illness and mental health conditions. The aim of this article was to deepen the understanding of creative writing and human becoming, from a caring science perspective. A data material consisting of answers from an e-form and diaries was analysed with a thematic analysis. The result depicts two main themes and seven subthemes. The first main theme, Creative writing - an act of emotional reactions and release, shows that creative writing is an act where fears and emotional reactions are unveiled; it is a relieving valve for the writer and includes moments of liberating wordplay. The second main theme, Creative writing - a key to self-understanding and personal growth, shows that creative writing is a genuine conveying of oneself to others, to experience mercifulness within oneself, to keep up faith in oneself and hope for the future and to find a new order of values. Creative writing enhances human becoming and gives possibilities for human beings to find inner peace and balance in life.

Using a Flexible Diary Method Rigorously and Sensitively With Family Carers

Health and social science researchers are increasingly interested in the range of new possibilities and benefits associated with diary methods, particularly using digital devices. In this article, we explore how a flexible diary method, which enables participants to choose the device (i.e., paper notebook, tablet, or computer) and medium (i.e., text, photographs, sketches) through which they narrate their experiences, can be used to promote sensitive and rigorous research engagement with family carers to people with dementia. We used a diary interview method with 10 carers over the course of 6 weeks to explore how they experience and interpret the changing behaviors of their cognitively impaired kin. We reflect on how the quality of diary data can be enhanced alongside the ethical dimensions of research with carer populations, through different forms of diary keeping, regular interaction with participants, reflexive practice, and follow-up interviews.

The challenges to public health nurse practice in rural Ireland

OBJECTIVES

The primary objective was to understand the contemporary public health nurse's (PHN) role and the issues that they face working in rural Ireland.

DESIGN AND SAMPLE

This study was based on an ethnographic approach with 13 PHNs working in rural areas in the South West of Ireland.

MEASUREMENTS

A combination of solicited diaries and semi-structured interviews referred to as the diary/interview method were employed. Diaries were used by the PHNs to record their working day on a staggered basis from February to April 2017 with the subsequent interviews carried out in June and July 2017.

RESULTS

Working as a PHN in a rural area presented a number of issues such as time spent on traveling as a result of geographical disparity & poor road networks; client transport issues; a sense of working in isolation; communication issues with respect to computer/tablet hardware availability, mobile phone and broadband connectivity and the availability of, and the physical access to services.

CONCLUSION

PHNs operating in rural communities face a distinct set of challenges that they have a limited ability to address. Legislators, health care providers and policymakers need to create a supportive environment that helps address these challenges in Ireland.

Structure and content of diaries written by close relatives for intensive care unit patients: A narrative approach (DRIP study)

AIM

To investigate structure and content of a nurse prompted diary written by relatives for intensive care unit (ICU) patients.

DESIGN

A narrative analysis of ICU diaries.

METHODS

From September 2015-August 2016, 12 diaries authored by 12 relatives for 12 ICU patients were sampled at 3-4 months post-ICU discharge. We used Ricoeur's hermeneutical phenomenology as a framework for a narrative analysis of the diaries. The first step was naïve reading, followed by structural analysis exploring the internal relations of the text. The structural analysis was broadened by exploring narrative structures. The last step was critical interpretation of the findings.

FINDINGS

The diaries had a clear narrative structure; the diary-timeline consisted of: Pre-ICU phase, Early ICU phase, Culmination, Recovery and Post-ICU reflection. Three themes described the content of the diary: Struggling to get the story right for the patient; striving to understand what was happening and longing to re-establish a connection with the patient. Keeping a diary was perceived by the relatives as a challenging but rewarding task.

CONCLUSION

The diary had the potential for reflection and a deeper understanding of the ICU stay. The diary served as a locus for patient and relatives to connect or re-connect, but some diaries might be too personal and emotional to share with the patient. Future research needs to explore advantages and disadvantages of ICU diaries authored by relatives.

Using diaries to collect data in phenomenological research

BACKGROUND

Collecting data in phenomenological research can be difficult and an often under-explored area of data collection is the use of diaries.

AIM

To enable the reader to understand how diaries can be used to collect data in phenomenological research.

DISCUSSION

The author discusses how diaries can provide unadulterated insight into a phenomenon.

CONCLUSION

Diaries can be useful to gain a personal insight into a phenomenon.

IMPLICATIONS FOR PRACTICE

Diaries can be a challenge for those maintaining them, but offer a personal insight which can be useful as a data collection method and also cathartic for the participant.

Integrated Household Surveys: An Assessment of U.S. Methods and an Innovation

We present a vision for improving household financial surveys by integrating responses from questionnaires more completely with financial statements and combining them with payments data from diaries. Integrated household financial accounts-balance sheet, income statement, and statement of cash flows-are used to assess the degree of integration in leading U.S. household surveys, focusing on inconsistencies in measures of the change in cash. Diaries of consumer payment choice can improve dynamic integration. Using payments data, we construct a statement of liquidity flows: a detailed analysis of currency, checking accounts, prepaid cards, credit cards, and other payment instruments, consistent with conventional cash-flows measures and the other financial accounts.

Implications for research and practice of the biographic approach for storytelling

Background Intensive care unit survivors face many physical and psychological difficulties during their recovery following discharge from hospital. These difficulties can significantly affect their quality of life. Healthcare providers and survivors' families often do not understand what recovery means in this population, which may affect the support provided. Aim To consider the potential of the biographical method in helping to create stories that illustrate recovery in intensive care survivors and other populations. Discussion This paper identifies how the biographical approach has provided survivors with a way to uncover the hidden parts of their lives through diaries and interviews, and reveal the hidden stories of intensive care survivorship and recovery. Conclusion The application of the biographical method enabled stories to be created that identified the disruption survivors encounter as they struggle to appear recovered. Implications for practice The biographical method can illuminate experiences uncaptured by other methods. This insight into recovery journeys can help healthcare practitioners and family members to understand and recognise the need for support during recovery.

Effects of intensive longitudinal data collection on pregnancy and contraceptive use

We use an experiment based on the Relationship Dynamics and Social Life (RDSL) study of sexual behavior, pregnancy, and contraceptive use to investigate whether participation in weekly self-reports over one year result in differential effects on related behaviors and attitudes, compared to participation in a one-time follow-up interview requiring retrospective self-reporting for the prior year. We randomly assigned 200 subjects to either a control group or a journal group. All subjects were interviewed at the beginning of the study (baseline interview) and 12 months later (closeout interview). Subjects in the journal group also completed a five-minute web- or phone-based survey every week during the 12-month study period. We found no statistically significant difference in pregnancy rates across the two groups at closeout. Contrary to our expectation, the control group experienced a slightly larger increase in having ever used a contraceptive method, although this was mainly due to increases in the least effective methods, such as condoms and withdrawal. Respondents in the weekly interview group became slightly more positive toward childbearing in terms of one specific attitude measure, but not for the vast majority of measures. We conclude that intensive longitudinal data collection does not appear to have a large or consistent impact on respondents' pregnancy, contraceptive use, or related attitudes, relative to the more standard longitudinal approach.

To be or not to be: How ethnic/racial stereotypes influence ethnic/racial disidentification and psychological mood

OBJECTIVES

The current study explores disidentification. Ethnic/racial disidentification is defined as psychological distancing from a threatened social identity to preserve a positive sense of self. The first study goal was to explore how daily ethnic/racial stereotype appraisal is related to ethnic/racial disidentification. The second goal was explore the association between disidentification and psychological mood. In both cases, centrality and private regard were considered individual differences that might moderate daily associations.

METHOD

Ethnic/racial minority young adults (Mage = 20.63 years, SD = 1.49; N = 129) completed a 21-day daily diary, including ethnic/racial stereotype appraisal, ethnic/racial disidentification, and mood. At the end of the study, participants completed measures of ethnic/racial centrality and private regard.

RESULTS

The effect of daily stereotype appraisal on disidentification depended on feelings of centrality and private regard. Young adults reporting high centrality and high private regard reported higher disidentification on days on which they reported more stereotype appraisal. These same young adults also reported higher negative mood on days on which they reported disidentification. Young adults reporting high private regard reported less positive mood on days on which they reported disidentification, whereas those reporting low private regard reported more positive mood.

CONCLUSION

This article discusses the role of ethnic/racial disidentification as a normative negotiation of threats to ethnic/racial identity development. For young adults who report high levels of centrality and private regard, daily encounters with ethnic/racial stereotypes are associated with more disidentification, but that disidentification comes at a cost in the form of more negative daily mood.

"Bring Your Own Device" (BYOD): The Future of Field-Based Patient-Reported Outcome Data Collection in Clinical Trials?

Field-based patient-reported outcome (PRO) assessments, including measures of signs, symptoms, and events that are administered outside of the research clinic, can be critical in evaluating the efficacy and safety of new medical treatments. Collection of this type of data commonly involves providing subjects with stand-alone electronic devices, such as smartphones, that they can use to respond to assessments in their home or work environment. Although this approach has proven useful, it is also limited in several ways: For example, provisioning stand-alone devices can be costly for sponsors, and requiring subjects to carry a device that is exclusively dedicated to the study can be burdensome. The "Bring Your Own Device" (BYOD) approach, in which subjects use their own smartphone or Internet-enabled device to complete field-based PRO assessments, addresses many of these concerns. However, the BYOD model has its own limitations that should be considered. In this article, representatives of the ePRO Consortium review operational, privacy/security, and scientific/regulatory considerations regarding BYOD. We hope that this review will allow researchers to make informed decisions when choosing methods to collect field-based PRO data in future clinical trials. Additionally, we hope that the discussion in this article will establish a research agenda for further examination of BYOD approaches.

The complexity of role balance: support for the Model of Juggling Occupations

OBJECTIVE

This pilot study aimed to establish the appropriateness of the Model of Juggling Occupations in exploring the complex experience of role balance amongst working women with family responsibilities living in Perth, Australia.

METHODS

In meeting this aim, an evaluation was conducted of a case study design, where data were collected through a questionnaire, time diary, and interview.

RESULTS

Overall role balance varied over time and across participants. Positive indicators of role balance occurred frequently in the questionnaires and time diaries, despite the interviews revealing a predominance of negative evaluations of role balance. Between-role balance was achieved through compatible role overlap, buffering, and renewal. An exploration of within-role balance factors demonstrated that occupational participation, values, interests, personal causation, and habits were related to role balance.

CONCLUSIONS

This pilot study concluded that the Model of Juggling Occupations is an appropriate conceptual framework to explore the complex and dynamic experience of role balance amongst working women with family responsibilities. It was also confirmed that the case study design, including the questionnaire, time diary, and interview methods, is suitable for researching role balance from this perspective.

The influence of daily routines on engaging in diabetes self-management

OBJECTIVE

In contrast to previous research concerning the importance of routines in occupational engagement, most of which have largely focused on the routines of children and families, in this study a qualitative methodology was used to understand how routines function in a specific occupation: diabetes self-management (DSM).

METHODS

Ten low-income women participated in a multiple-methods study that involved completing a time-geographic diary (TGD) and participating in a TGD interview.

RESULTS

Findings reveal that pre-existing routines must be changed so that they may better support engagement in DSM, and that such changes are tied to underlying habits and life situations. The experiences of study participants also showed that the distribution of daily occupations through time and across social spheres can be both supportive of and problematic for engaging in DSM. In addition, the structure and sequence of competing daily occupations influences the available time and opportunities for people to further develop their skills and become more adept self-managers.

CONCLUSIONS

The implications of these findings for occupational science and therapy are discussed.

Web-based sex diaries and young adult men who have sex with men: assessing feasibility, reactivity, and data agreement

We compared quantitative diary data with retrospective survey data collected from a cohort of young adult men who have sex with men (MSM) in Seattle, Washington. Ninety-five MSM, aged 16-30 years, completed web-based surveys every 3 months and were randomized to 4 diary submission schedules: every 2 weeks, once a week, twice a week, or never. We calculated diary completion rates and assessed agreement between daily diary data and aggregate retrospective survey data for sexual behavior measures. Over 6 months, 78 % of participants completed at least 80 % of their diary days, and the 2-week schedule had the highest and most consistent completion rate. The majority of sexual behavior and substance use measures had strong agreement between the diary and retrospective survey data (i.e., kappa >0.80 or concordance correlation coefficient ≥0.75), although we observed poorer agreement for some measures of numbers of anal sex acts. There were no significant differences in mean responses across diary schedules. We observed some evidence of reactivity (i.e., a difference in behavior associated with diary completion). Participants not assigned diaries reported significantly more unprotected anal sex acts and were more likely to be newly diagnosed with HIV or another sexually transmitted infection compared to those assigned active diary schedules. This study suggests that sexual behavior data collected from young adult MSM during 3-month retrospective survey--an interval commonly used in sexual behavior research--are likely valid. Diaries, however, may have greater utility in sexual behavioral research in which counts, timing, sequence, or within-person variation over time are of particular import.

The experience of pregnancy: a hermeneutical/phenomenological study

The aim of this study was to describe women's experience of pregnancy. The setting was the Alternative Birth Center at Sahlgrenska University Hospital in Göteborg, Sweden, from 1996 to 1997. Anonymous diaries were written by 12 women and analyzed using a hermeneutical/phenomenological approach. The essential structure and interpretation of women's experience of pregnancy can be expressed as "transition to the unknown," which includes three themes: (1) meeting one's life situation, (2) meeting something inevitable, and (3) preparing for the unknown.The essential structure and interpretation of women's experience of pregnancy can be expressed as "transition to the unknown" …

A cognitive analysis of college students' explanations for engaging in unprotected sexual intercourse

Young adults, including college students, engage in high levels of unprotected sexual activity despite relatively high rates of HIV/STI and pregnancy-related knowledge. Little is known about the cognitive strategies that young people use to explain this inconsistency. The current study examined young people's explanations for engaging in unprotected sexual activity in their committed relationships. A total of 63 young adults (32 women and 31 men) completed daily diaries over a 3-week period, providing a total of 1,284 daily reports tracking their condom use and non-use during intercourse. Diary collection was followed by in-depth interviews designed to explore participants' decision-making regarding their participation in sexual intercourse unprotected against infection or unwanted pregnancy. Less than a quarter of the sample used condoms or oral contraceptives consistently. Participants primarily viewed condoms as a means of preventing pregnancy; few described disease prevention as a main motivation for their use. Analysis of the cognitions underlying explanations for condom and contraception non-use were classified as (1) general biased risk evaluation, (2) biased evidence evaluation, (3) endorsement of poor alternatives, (4) focus on spurious justifications, (5) dismissing risk, and (6) ignoring risk. Prevention interventions should incorporate methods to challenge young people to acknowledge personal risk and commit themselves to taking steps to reduce this risk.

Adherence and weight loss outcomes associated with food-exercise diary preference in a military weight management program

The more consistently someone records their food intake the more likely they are to lose weight. We hypothesized that subjects who kept track via their preferred method would demonstrate higher adherence and therefore improved outcomes compared to those who used a non-preferred method. Participants were randomly assigned to use a paper, PDA, or Web-based diary and classified as "Preferred" if they used their preferred method and "Non-Preferred" if they did not. Days adherent to diary use were collected for 12 weeks. Weight, % body fat, waist circumference, and self-efficacy scores were measured at baseline, 6 and 12 weeks. Thirty nine participants completed the 12 week study. Fifty nine percent were male. The mean age was 35 and mean baseline BMI was 33 kg/m(2) (+/-3.5). Forty four % (n=17) used their "Preferred" diary method and 56% (n=22) did not. Participants who used their preferred diary were more adherent to recording both food intake (64.2% vs. 43.4%, p=.015) and exercise (60.6% vs. 31.2%, p=.001). Though no difference was seen between groups on weight management outcomes, these results suggest that diary preference affects adherence to diary use.

Sexual intercourse and risk of symptomatic urinary tract infection in post-menopausal women

BACKGROUND

Sexual intercourse increases the risk of symptomatic urinary tract infections (UTI) in young women, but its role among post-menopausal women is unclear.

OBJECTIVE

To determine whether recent sexual intercourse, as documented by daily diaries, is associated with an increased risk of symptomatic UTI in post-menopausal women.

DESIGN

A 2-year prospective cohort study conducted from 1998 to 2002.

PARTICIPANTS

One thousand and seventeen randomly selected post-menopausal women enrolled at Group Health Cooperative (GHC), a Washington State HMO.

MEASUREMENTS AND MAIN RESULTS

Women were asked to enter daily diary information on vaginal intercourse, medication use, and genito-urinary symptoms. The outcome of interest, symptomatic UTI, was defined as a positive urine culture >/=10(5) CFU/mL of a uropathogen and the presence of >/=2 acute urinary symptoms. Nine hundred thirteen women returned diaries and were included in this study. Seventy-eight women experienced 108 symptomatic UTIs, and 361 (40%) reported sexual intercourse in their diaries. There was an increased hazard for UTI 2 calendar days after the reporting of sexual intercourse in the diaries (adjusted hazard ratio [HR], 3.42, 95% CI 1.49-7.80), while there was no evidence for an increased hazard associated with intercourse at other times. When the UTI criterion was relaxed from >/=10(5) CFU/mL to >/=10(4) CFU/mL, adding 9 UTI events to the analysis, the HR for UTI 2 days after intercourse changed slightly to 3.26 (95% CI 1.43-7.43).

CONCLUSIONS

Our data suggest that, as with younger women, recent sexual intercourse is strongly associated with incident UTI in generally healthy post-menopausal women.