Emotional Upset Research Articles

Examining the support needs of ageing family carers in developing future plans for a relative with an intellectual disability

Planning for the future care of adults with an intellectual disability after the main family carer ceases their care, continues to be a sensitive and difficult time posing challenges for service providers internationally. Limited research has been undertaken on this topic because until recently, people with intellectual disability usually pre-deceased their parents. This study examined ageing carers' preferences for future care and the support systems required to make such future plans. The study was conducted in one region of the United Kingdom with a high proportion of family carers. A mixed methods design was employed. In Stage 1, a structured questionnaire was used to collate information on the health, caregiving demands and future planning preferences of 112 parent and sibling carers; aged 60-94 years. In Stage 2, 19 in-depth semistructured interviews were undertaken with a sample of carers to explore a range of issues around future planning. Over half of the carers were lone carers, mainly female, with many reporting a wide range of health problems. A third of these carers reported that their caregiving resulted in high levels of anxiety. The main preference of the carers was for the person to remain in the family home, with either the family and/or paid staff to support them. A minority of parent carers preferred the person to move into the home of a sibling, although some favoured the person moving to a residential facility with other people with intellectual disabilities. The majority of carers did not want their relative to move into an older people's residential/nursing facility. In the qualitative data, four main themes were identified around future planning: unremitting apprehension, the extent of planning, obstacles encountered and solutions for future planning. Avoidance, lack of guidance and a lack of appropriate residential provision were cited as obstacles to making future plans compounded by the emotional upset experienced by carers in thinking about the future. Findings of this study clearly identify the emotional, informational and practical supports required by these ageing family carers. These findings have national and international relevance in influencing how governments and service providers support parent and sibling carers to proactively plan for the future, and in the development of both in-home and out-of-home options when a family carer can no longer provide care. This is more urgent than ever given the growing numbers of older persons with intellectual disabilities in future decades.

Temporal changes in innate immune signals in a rat model of alcohol withdrawal in emotional and cardiorespiratory homeostatic nuclei

BackgroundChronic alcohol use changes the brain’s inflammatory state. However, there is little work examining the progression of the cytokine response during alcohol withdrawal, a period of profound autonomic and emotional upset. This study examines the inflammatory response in the central nucleus of the amygdala (CeA) and dorsal vagal complex (DVC), brain regions neuroanatomically associated with affective and cardiorespiratory regulation in an in vivo rat model of withdrawal following a single chronic exposure.MethodsFor qRT-PCR studies, we measured the expression of TNF-α, NOS-2, Ccl2 (MCP-1), MHC II invariant chain CD74, and the TNF receptor Tnfrsf1a in CeA and DVC samples from adult male rats exposed to a liquid alcohol diet for thirty-five days and in similarly treated animals at four hours and forty-eight hours following alcohol withdrawal. ANOVA was used to identify statistically significant treatment effects. Immunohistochemistry (IHC) and confocal microscopy were performed in a second set of animals during chronic alcohol exposure and subsequent 48-hour withdrawal.ResultsFollowing a chronic alcohol exposure, withdrawal resulted in a statistically significant increase in the expression of mRNAs specific for innate immune markers Ccl2, TNF-α, NOS-2, Tnfrsf1a, and CD74. This response was present in both the CeA and DVC and most prominent at 48 hours. Confocal IHC of samples taken 48 hours into withdrawal demonstrate the presence of TNF-α staining surrounding cells expressing the neural marker NeuN and endothelial cells colabeled with ICAM-1 (CD54) and RECA-1, markers associated with an inflammatory response. Again, findings were consistent in both brain regions.ConclusionsThis study demonstrates the rapid induction of Ccl2, TNF-α, NOS-2, Tnfrsf1a and CD74 expression during alcohol withdrawal in both the CeA and DVC. IHC dual labeling showed an increase in TNF-α surrounding neurons and ICAM-1 on vascular endothelial cells 48 hours into withdrawal, confirming the inflammatory response at the protein level. These findings suggest that an abrupt cessation of alcohol intake leads to an acute central nervous system (CNS) inflammatory response in these regions that regulate autonomic and emotional state.

Triggering of supraventricular premature beats. The impact of acute and chronic risk factors

Supraventricular premature beat (SPB) is usually considered a benign heart rhythm disturbance. However, an isolated SPB can trigger episodes of atrial fibrillation [1,2], supraventricular tachycardia [3] and malignant ventricular tachyarrhythmia [4,5]. A high frequency of SPB has been linked to the increased risk of death or stroke [6,7]. Circadian, weekly and annual variations in the occurrence of ventricular tachyarrhythmias and triggering by emotional and physical stress have been well-described [8–14]. Until now, factors that could be involved in the triggering of supraventricular arrhythmias have not been rigorously investigated. Consecutive patients who underwent continuous 24-hour Holter monitoring between January and April 2001 in the Diagnostic Units of the Division of Cardiology, Department of Internal Medicine, University Hospital Split, Split, Croatia (n=501), were eligible for inclusion in the analysis. Patients who were unable to complete the diary, had atrial fibrillation, or their ECG recordings were inaccurate due to artifacts were excluded from the analysis (n=63). The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Ethics Committee of the University Hospital Split. All participants gave their informed consent. The authors of this article have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [15]. The identification of SPB was based on 3 criteria: prematurity, morphology, and postcontraction pause. An SPBwas defined as a QRS of less than 0.12 seconds with a minimum shortening of 20% in the R-R interval. QRS complexes of duration of more than 0.12 seconds were considered SPB only if aberration was suspected. The postcontraction pause had to be noncompensatory. Differentiation from sinus arrhythmia was made according to the P-wave morphology, cyclic changes in preceding R-R intervals, or both. Activity compatible with level 4 or more according to a metabolic equivalents scale from 1 to 8 was considered as exposure to physical activity. Exposure to emotional upset was defined as an emotional state compatible with level 3 or more according to the Onset Anger Scale [8,10,16]. Meteorologic parameters (atmospheric temperature and pressure, relative airmoisture, wind speed and direction, rainfall and passages of coldorwarmatmospheric fronts)wereprovided for every 3 hours (at 1, 4, 7 and10AM, and1, 4, 7 and10PM). The frequencyof SPB in anhourwas expressed as a percentage of all episodes during recordingwhich reduced the distribution of absolute number of SPB during monitoring and made the data normally distributed. Linear regression analysis was used to investigate the direct impact of continuous meteorologic factors, repeated measures analysis of variance (ANOVA) to estimate whether the frequencies of SPB differed according to time of day, a two-way ANOVA to assess whether the circadian pattern of SPB occurrence depended on baseline characteristic and multi-way ANOVA was used to investigate the frequency of SPB according to physical, emotional and meteorologic stressors. A stepwise multiple regression analysis was used to simultaneously assess the independent predictive significance of both acute triggering and chronic (conventional) risk factors and medication. Baseline characteristics of the 438 participants are given in Table 1 and preliminary models for multivariate analysis according to age and gender are given in Table 2. Physical activity, followed by the periods of increasing relative air moisture (Fig. 1), showed the strongest association with the occurrence of SPB and both remained significant predictors in all participant subgroups (Tables 3 and 4). The occurrence of SPB was somewhat higher during blowing of southerly and westerly winds (Fig. 2), but after adjustment for other external triggering factors the significance of this difference disappeared (p=0.77). Atmospheric pressure was a predictor of SPB in men, while lower levels of relative air moisture and passage of

The Body, Diseases and Their Relationship to Trauma and Stress

When trauma strikes, it creates an emotional upset that disrupts our mental and physical metabolism; thereby, affecting our wellbeing. Often the symptoms of this disruption manifests in what we see as psychological problems in individual personality traits such as intrusion, anxiety, depression, paranoia, ADHD in children, schizophrenia and other antisocial behaviors commonly manifested from PTSD. What is not widely talked about are the devastating side effects of trauma that destroys not just the mind, but the body. (Biography, 2011; Answers.com, 2011; Roland, 2011) When the body is exposed to long term stress or trauma the adrenaline gland has a systems overload burning the wires that block cortisol. Therefore excessive amounts of cortisol are produced that cause biological malfunctions. This paper explores those unintended consequences of stress.

‘Non-steroidal drug-induced glaucoma’ by MR Razeghinejad, MJ Pro and LJ Katz

Sir, In this review,1 the authors conclude that ‘the majority of cases of drug induced CAG are of the pupillary block closed angle type and preventable …'—a claim unsupported by any evidence other than anecdotal case reports. In the elderly, a significant number of patients will have narrow angles,2 with a prevalence of CAG in Caucasian eyes as high as 0.6%.3 The authors have not shown that systemic anticholinergic or sympathomimetic drugs are more important than other known precipitating factors of CAG, such as emotional upset, dim illumination, reading or the prone position.2 The reference for their figure that ‘at least one third of acute closed angle glaucoma (ACAG) cases are related to over-the-counter or prescription drugs' is a paper discussing risk factors in open-angle glaucoma.4 The authors' view that systemic anticholinergic or sympathomimetic medication can cause pupillary dilatation, which precipitates pupillary block CAG, is unsubstantiated. The risk of inducing ACAG has been shown to be zero with tropicamide and between 1 in 4000, and 1 in 20 000, when using long-acting or combined agents.5 It is unlikely, therefore, that the minimal degree of pupil dilatation produced by systemic medications could induce CAG. The authors warn that ‘Mapstone reported severe IOP elevation, following tropicamide dilation in 19 out of 58 patients …'.6 These 58 eyes in Mapstone's study were all eyes with untreated angle-closure glaucoma and were dilated with tropicamide as part of a study of agents to use in provocative testing. The pressure rise in the 19 responding eyes was a mean pressure rise from 18 to 30 mm Hg, and all pressures returned to normal within 2 h of installation of the topical pilocarpine and systemic acetazolamide. As idiopathic ACAG is almost always unilateral,2 the unilateral nature of ACAG in the case reports would suggest that the ACAG is idiopathic. CAG arises from an anatomical pre-disposition in the ageing eye,2 and contrary to the conclusions of Razeghinejad et al,1 there is no evidence that the use of systemic medications increases the risk of the development of pupillary block CAG.

COGNITIVE BEHAVIOR THERAPY COMPARE TO CAMPAIGN ADVERTISEMENT PROGRAMS IN REDUCING AGGRESSIVE DRIVING BEHAVIOR

This study was conducted to examine the effectiveness of three intervention programs, i.e. CBT (Cognitive Behavior Therapy), humor appeal advertisements (positive ads), and fear appeal advertisements (negative ads) in reducing aggressive driving behavior. 196 young adults age between 18–35 years old, who are considered to be at risk in performing aggressive driving behavior had completed four self report inventories. The four inventories measures perception on traffic conditions, degree of frustration, anger emotion, and driving behavior. Analysis of mix factorial desigm shows that CBT intervention program is more effective than the advertising intervention program, particularly in reducing the degree of frustration and emotional upset. However, no significant difference between humor appeal and fear appeal advertisements in reducing the level of frustration and anger emotion. Moreover, CBT program as well as the other two advertising intervention programs is not sufficient enough to reduce driving behavior. Based on the A-BC Theory of Emotonal Arousal proposed by Ellis, this result indicates that safety driving behavior (factor C) among young drivers cannot be achieved through these intervention programs, although their belief and emotion (factor B) has been changed. This study implies that other modification behavior technique, i.e. strong penalty from the author (police) is needed to encourage safer driving behavior of Indonesian young driver

Chronic Grief Management for Dementia Caregivers in Transition: Intervention Development and Implementation

Research reveals that Alzheimer's disease (AD) caregivers do not relinquish their role after placing a family member in long-term care. Caregivers report increased emotional upset around the time of placement, with sustained losses over time leading to chronic grief. Chronic grief increases caregivers' risk for depression and suicide. There are no documented interventions designed to decrease caregivers' chronic grief post placement. The Chronic Grief Management Intervention (CGMI) builds on existing evidence to target caregivers' chronic grief in the transition of a family member into long-term care. The intervention is structured into three major components: (a) knowledge, (b) communication and conflict resolution skills, and (c) chronic grief management skills. The 12-week intervention was pilot tested with 34 caregivers for feasibility and preliminary effects on caregiver skill, knowledge, chronic grief, and depression. This article presents a general study description while focusing on the development and implementation of the CGMI.

Distress and emotional well-being in breast cancer patients prior to radiotherapy: an expectancy-based model

Understanding precursors to distress and emotional well-being (EWB) experienced in anticipation of radiotherapy would facilitate the ability to intervene with this emotional upset (i.e. higher distress, lower EWB). Thus, this study tested an expectancy-based model for explaining emotional upset in breast cancer patients prior to radiotherapy. Women affected by breast cancer (N = 106) were recruited and participants completed questionnaires prior to commencing radiotherapy. Structural equation modelling was used to test a cross-sectional model, which assessed the ability of dispositional optimism (Life Orientation Test-Revised – two factors), response expectancies (Visual Analog Scale items), medical (type of surgery, cancer stage and chemotherapy history) and demographic (age, race, ethnicity, education and marital status) variables to predict both EWB (Functional Assessment of Chronic Illness Therapy – Emotional Well-being Subscale) and distress (Profile of Mood States – short version). The model represented a good fit to the data accounting for 65% of the variance in EWB and 69% in distress. Significant predictors of emotional upset were pessimism, response expectancies, Latina ethnicity, cancer stage and having had a mastectomy. These variables explained a large portion of emotional upset experienced prior to radiotherapy for breast cancer and are important to consider when aiming to reduce distress and improve EWB in this context.

Author's Reply:

We appreciate Dr. Čulić's interest in our study, “Role of Age, Sex, and Race on Cardiac and Total Mortality Associated With Super Bowl Wins and Losses.”1 In the study we showed that Los Angeles' Super Bowl loss of 1980, a very intense game with numerous lead changes, was associated with increased mortality in men and women, whereas just 4 years later, Los Angeles' Super Bowl win, a less intense game, was associated with a reduction in mortality, especially in women.1 Here are our responses to Dr. Čulić's letter. We picked 14 days based on the concept that an emotional upset related to an intense game lost by a home team might linger beyond the actual game. For example, negative emotions might be stimulated by negative press about the loss, negative conversations among family and friends, and possible loss of money due to betting. It turns out that most of the excess death occurred within the first week following the game. Christmas and New Year's were not included because of the well-known increase in death and cardiac death around the winter holiday time. Including this data would not have contributed to a better understanding of the Super Bowl data. If the concern is controlling for environmental factors, then 1 way to do this was to analyze dates after the known confounder of the winter holidays, which we did. Although we agree that environmental factors such as seasons, temperature, and pollution have the potential to contribute to cardiac triggers, they alone could not have fully explained our findings. Note that in contrasting the 2 games (1980 loss vs 1984 win) the time of year could not have contributed. These games were played at nearly identical times of the year: January 20, 1980 vs January 22, 1984. The temperatures in Los Angeles were very mild at both times: 52.9°F average temperature on January 20, 1980 and 54.5°F average on January 22, 1984. Average maximal temperature was 66.4°F and 69.0°F in January 1980 and February 1980, respectively, and was 67.8°F and 67.7°F in January 1984 and February 1984, respectively. It is unlikely that small temperature differences alone could have explained the results. In addition, had temperature been an issue, one would have expected either a cold spell or heat wave on the 1980 Super Bowl-related days. However, there was neither a cold snap nor a heat wave during the 1980 Super Bowl-related days when we analyzed daily average temperatures from January 15, 1980 to February 28, 1980. Furthermore, data available from Aerometric Data Analysis and Management Systems for the State of California for 24-hour total suspended particulate averages during the Super Bowl time frames averaged 113 micrograms per cubic meter (4 readings) in 1980 and 129 micrograms per cubic meter (3 readings) in 1984. Maximum 1-hour total hydrocarbon measurements during the Super Bowl time frames averaged 5.36 parts per million carbon (from 15 readings) in 1980 and 6.88 parts per million carbon (from 15 readings) in 1984. These data do not support more air pollution at the time of the 1980 Super Bowl loss compared to the 1984 Super Bowl win. We agree that future studies should try to take into account environmental factors. However, there is insufficient evidence to state that the findings of our study are based solely on environmental factors. Robert A. Kloner MD, PhD*, Scott A. McDonald BS , W. Kenneth Poole PhD , * Heart Institute, Good Samaritan Hospital Keck School of Medicine at University of Southern California Los Angeles, California, RTI International Research Triangle Park, North Carolina

Body-conscious Shakespeare: sensory disturbances in troubled characters

It is widely accepted that Shakespeare was unique in the range of his insights into the human mind, but the way his characters reveal their mental states through bodily sensations...

Effects of Cognitive Complexity and Emotional Upset on Processing Supportive Messages: Two Tests of a Dual-Process Theory of Supportive Communication Outcomes

We report tests of hypotheses derived from a theory of supportive communication outcomes that maintains the effects of supportive messages are moderated by factors influencing the motivation and ability to process these messages. Participants in two studies completed a measure of cognitive complexity, which provided an assessment of processing ability, and reported their degree of upset with a problem situation, which was hypothesized to impact both motivation and ability; they subsequently evaluated the helpfulness of comforting messages that varied in person centeredness. Consistent with predictions, an index of message processing depth—the degree to which participants discriminated between the helpfulness of better and worse supportive messages—was associated with the factors additively in both studies and interactively in one study. Los Efectos de la Complejidad Cognitiva y el Disgusto Emocional sobre el Procesamiento de Mensajes de Apoyo: Dos Pruebas de la Teoria de Proceso Doble de los Resultados de la Comunicacion de Apoyo Reportamos las pruebas de las hipotesis derivadas de una teoria de los resultados de la comunicacion de apoyo que sostiene que los efectos de los mensajes de apoyo son moderados por factores que influencian la motivacion y la habilidad de procesar estos mensajes. Los participantes en los dos estudios completaron una medida de la complejidad cognitiva, la cual proveyo de un asesoramiento de la habilidad de procesamiento, y reporto el grado de disgusto con una situacion problematica, la cual deberia impactar la motivacion y la habilidad; subsecuentemente ellos evaluaron cuan beneficioso eran los mensajes de apoyo que variaron en la centralidad de la persona. Consistente con las predicciones, un indice de la profundidad del procesamiento del mensaje–el grado en que los participantes discernieron entre el beneficio de los mensajes de apoyo mejores y peores–estuvo asociado con los factores aditivamente en ambos estudios e interactivamente en uno de los estudios. Palabras claves: complejidad cognitiva, modelos de proceso doble, apoyo emocional, recepcion de mensaje, apoyo social, escucha Die Wirkung von kognitiver Komplexitat und emotionaler Sensation auf die Verarbeitung von hilfreichen Botschaften: Zwei Tests einer Dualprozesstheorie zu Folgen unterstutzender Kommunikation Wir berichten uber den Test von Hypothesen, die aus der Theorie zu Folgen von unterstutzender Kommunikation extrahiert wurden und postulieren, dass die Wirkung von hilfreichen Botschaften durch Faktoren moderiert wird, die die Motivation und die Fahigkeit beeinflussen, diese Botschaften zu verarbeiten. Die Teilnehmer nahmen an zwei Studien teil. Sie vervollstandigten ein Messinstrument zur kognitiven Komplexitat, das zur Beurteilung der Verarbeitungsfahigkeit diente und gaben auserdem Auskunft daruber, wie sehr sich durch eine problematische Situation, die Motivation und Fahigkeit beeinflussen sollte, aus der Fassung gebracht wurden. Im Anschluss bewerteten sie den Nutzen beruhigender Botschaften, die bezuglich ihrer Fokussierung auf eine Person variierten. Im Einklang mit den Annahmen, war ein Index der Botschaftsverarbeitungstiefe (der Grad, zu welchem die Teilnehmer zwischen dem Nutzen von besseren und schlechteren hilfreichen Botschaften unterschieden) in beiden Studien additiv, in einer Studie interaktiv verknupft mit diesen Faktoren. Schlusselbegriffe: kognitive Komplexitat, Dualprozessmodelle, emotionale Unterstutzung, Botschaftsrezeption, soziale Unterstutzung, Zuhoren Les effets de la complexite cognitive et de la contrarieteemotive sur le traitement des messages de soutien : deux tests d’une theorie a deux temps des resultats de la communication de soutien Nous rendons compte de tests d’hypotheses derivees d’une theorie des resultats de la communication de soutien qui affirme que les effets des messages de soutien sont attenues par des facteurs influencant la motivation et la capacitea traiter ces messages. Les participants a deux etudes ont complete une mesure de la complexite cognitive (ce qui a fourni une evaluation de la capacite de traitement) et ont declare leur niveau de contrariete face a une situation problematique (ce qui devrait influencer la motivation et la capacite). Ils ont ensuite evalue l’utilite de messages de reconfort variant dans la centralite qu’ils donnaient a la personne. Conformement aux predictions, un indice de profondeur dans le traitement du message (le degre auquel les participants discriminaient entre l’utilite de meilleurs et de pires messages de soutien) etait associe aux facteurs de maniere additive dans les deux etudes et de maniere interactive dans une etude. Mots cles : complexite cognitive, modeles a deux temps, soutien emotionnel, reception des messages, soutien social, ecoute

Family members' views and experiences of discussing preferences and wishes for end-of-life care

AimThis study is part of a larger cross-sectional study exploring the views of people affected by lung cancer about their experiences of discussing preferences and wishes for end of life...

Cognitive predictors of posttraumatic stress symptoms six months following acute coronary syndrome

This study examined patients’ illness representations assessed shortly after an acute coronary syndrome (ACS) as predictors of posttraumatic stress symptoms six months later. Illness representations were assessed in ACS patients using standard measures at a home visit three weeks after discharge from hospital. Posttraumatic stress symptoms were assessed at the same time, and again six months later. Patients were aged 61 years on average, the majority being men (89.8%) of white European decent (89%). Greater posttraumatic symptoms at six months were associated with beliefs that the illness would last a long time (timeline), that it had an unpredictable time course (timeline – cyclical), greater consequences, less personal and treatment control, poorer illness coherence and stronger negative emotional representations (emotional upset relating to the illness; p < 0.05). In multiple regression analyses, controlling for demographic, clinical and psychological factors (age, gender, ethnicity, social deprivation, ACS severity, negative affectivity and cardiac symptom recurrence), more intense emotional representations (β = 0.146, p = 0.041) and reduced illness coherence (β = −0.133, p = 0.029), emerged as independent predictors of posttraumatic symptom severity at six months. There was a near significant effect for personal control (β = −0.113, p = 0.058). These results demonstrate the importance of illness representations of ACS in predicting longer-term posttraumatic stress symptoms.

Symptoms Associated With Dietary Fiber Supplementation Over Time in Individuals With Fecal Incontinence

Knowledge about adverse symptoms over time from fiber supplementation is lacking. The aim of this study was to compare the severity of adverse gastrointestinal (GI) symptoms during supplementation with dietary fiber or placebo over time in adults with fecal incontinence. A secondary aim was to determine the relationship between symptom severity and emotional upset and their association with study attrition and reducing fiber dose. Participants (N = 189; 77% female; 92% White; age, M = 58 years, SD = 14 years) with fecal incontinence were randomly assigned to a placebo or a supplement of 16 g total dietary fiber per day from 1 of 3 sources: gum arabic, psyllium, or carboxymethylcellulose. They reported GI symptoms daily during baseline (14 days), incremental fiber dosing (6 days), and 2 segments of steady full fiber dose (32 days total). Severity of symptoms in all groups was minimal. Adjusting for study segment and day, a greater feeling of fullness in the psyllium group was the only symptom that differed from symptoms in the placebo group. The odds of having greater severity of flatus, belching, fullness, and bloating were 1.2-2.0 times greater in the steady dose segment compared with baseline. There was a positive association between symptom severity and emotional upset. Participants with a greater feeling of fullness or bloating or higher scores for total symptom severity or emotional upset were more likely to withdraw from the study sooner or reduce fiber dose. Persons with fecal incontinence experience a variety of GI symptoms over time. Symptom severity and emotional upset appear to influence fiber tolerance and study attrition. Supplements seemed well tolerated.

Difficulties of Alternatively Certified Teachers

This daily diary study followed, over a 2-week period, 252 beginning New York City public school teachers. Seventy percent were alternatively certified (New York City Teaching Fellows) and the rest, traditionally certified teachers. Alternatively certified teachers were more likely to experience stressors such as violent incidents and classroom management problems. No differences were found in exposure to stressors/difficulties such as problematic adults, student learning problems, and students experiencing emotional upset. Although differences in the rates of exposure to violent stressors could be explained by other factors (e.g., working in a low-performing school and years of experience), differences in the rates of occurrence of classroom management problems could not. Nevertheless, the high absolute rates of management problems and violence in both groups of teachers were striking and need to be addressed. The authors suggest measures to be taken to address the problem of retaining talented new teachers.

An Exploratory study of compliance with dietary recommendations among college students majoring in health-related disciplines: application of the transtheoretical model.

Compliance with food group and nutrient recommendations, and self-efficacy, stage of change, perceived barriers and benefits for healthy eating were assessed among a convenience sample of college students majoring in health-related disciplines. Dietary and psychosocial data were collected using three-day food records and scales, respectively. Means (SD), frequencies, and percents were calculated on all data, and logistic regressions were used to determine whether any of the psychosocial correlates predicted the stage of change for healthy eating. Noncompliance with food group recommendations ranged from 53% for the meat/meat alternates group to 93% for the vegetables/juice group, whereas noncompliance with nutrient recommendations ranged from 26% for cholesterol to 99% for potassium. A majority of students (57%) self-classified in the preaction and 40% in the action stages of change for eating healthy. The students' self-efficacy to eat healthy was highest in positive/social situations and lowest when experiencing emotional upset. The most important perceived barrier to healthy eating was that friends/roommates do not like to eat healthy foods, and the most important perceived benefit was that eating healthy foods provides the body with adequate nutrients. The difficult/inconvenient self-efficacy subscale predicted the stage of change for healthy eating. These students would benefit from interactive learning opportunities that teach how to purchase and prepare more whole grain foods, fruits, and vegetables, enhance their self-efficacy for making healthy food choices when experiencing negative emotions, and overcome perceived barriers to healthy eating.

Randomized trial showed that an “embedded” survey strategy optimized authorization rates compared with two “after survey” strategies in veterans with PTSD

Objectives To test methods to optimize mail survey response and authorization rates (i.e., allowing one's survey to be linked to medical records) when the survey is sensitive and the targeted population has a mental disorder. Study Design and Setting Randomized controlled trial of 1,099 veterans treated for posttraumatic stress disorder (PTSD) at a Midwestern Veteran Affairs Medical Center. Subjects were randomized to one of three groups: (1) Health Insurance Portability and Accountability Act (HIPAA) authorization form embedded in the survey (checking “yes” for consent); (2) HIPAA form requiring signature for consent sent after the survey; or (3) HIPAA form requiring a signature and social security number (SSN) for consent sent after the survey. Results The “embedded” strategy yielded the lowest survey response rate (67.5%) but highest authorization rate (59.1%). Requiring respondents' signatures and SSNs after the survey was returned generated the highest survey response rate (74.2%) but lowest authorization rate (48.7%). However, the response rate difference was not statistically significant. Reported emotional upset was low (1.5%) and primarily directed to the survey, not the HIPAA form. Older age and greater trustfulness were associated with higher authorization rates. Conclusion Even with our most optimized strategy, authorization rates were disappointingly low.

An Investigation of Emotional Upset in Suicide Ideation

The Suicide Upsetness Assessment (SUA) was used to measure the phenomenological experience of emotional upset during active states of suicidal ideation. Forty-nine inpatients with a history of suicide-related behaviors at a Midwestern inpatient psychiatric hospital completed a battery of assessments during their inpatient hospital stay. After reviewing theories regarding suicidality by the research team, 6 separate categories related to suicidal ideation were created, which were then subdivided into groups. Chi-Square and Fisher Exact Tests provided information regarding characteristics of emotional upset most often associated with such suicide-related behaviors as frequency and lethality of past attempts. Emotional upset is a heterogeneous construct in suicidal individuals, the properties of which may provide for a more thorough risk assessment.

Health Literacy and Emotional Responses Related to Fecal Incontinence

The primary purpose of this study was to examine continence literacy of individuals with fecal incontinence (FI) by identifying terms they used to refer to FI and to explore their emotional responses to FI. A secondary aim was to compare differences based on gender and age in younger (<65 years) versus older persons (>65 years) with FI. Secondary analysis of data collected prospectively in a clinical trial of fiber supplementation for FI. Content analysis of participants' statements reported in field notes of data collectors and their responses to data forms and questions. Only one participant used the term fecal incontinence to describe FI. Alternate terms described stool characteristics, named other gastrointestinal problems, or respondents referred to FI, using a term that seemed to depersonalize the problem. Emotional responses to FI focused on the influence of bothersome symptoms, interference with social activities, and need for control. Some participants used humor to cope with FI and reported emotional benefits gained through participation in a study. Women were impacted by the social limitations of having FI more than men. Younger people were more likely to express feelings of emotional upset than were older respondents. There is a need to increase health literacy about FI. WOC nurses are well qualified to educate patients about FI and to evaluate if higher continence literacy increases reporting of FI. Understanding the various emotional responses to FI may guide the optimal support that WOC nurses can provide and facilitate better management of FI.

Cutaneous warts in children before and after renal transplantation

Cutaneous warts occur in 3.9-4.9% of children in the UK. The incidence is increased in organ transplant recipients and may be increased in patients with chronic kidney disease (CKD), since uraemia reduces the immune system's function. We surveyed the records from our CKD and renal transplant clinic to ensure patients with warts were identified and appropriately treated. Data were collected by questionnaire. The presence of warts, location, treatment, levels of pain and emotional upset were recorded. Nine of 49 (18.4%) pre-transplantation patients (33 male, median age 12.1 years) were currently suffering from warts compared with 17 of 60 (28.3%) post-transplantation patients (34 male, median age 13.9 years). A further 14 pre-transplantation and 16 post-transplantation patients had previously suffered from warts which had resolved. Forty-one patients had sought treatment for warts, mainly from primary care. Five patients, all having received transplants, were seen by a dermatologist. Self-rated levels of pain and emotional upset were generally low, apart from those of four adolescent patients who expressed significant emotional upset. We concluded that cutaneous warts are more common among CKD patients. Appropriate information and treatment are required before and after transplantation. The majority of warts can be treated in primary care, but selected patients with extensive warts that cause distress need early referral for dermatology opinion.