Home phototherapy using fiberoptic lights for the treatment of newborn hyperbilirubinemia has proven to be safe and effective. The purpose of this study was to explore whether differences in the outcomes of duration, reduction of bilirubin levels, hyperbilirubinemia resolution, or readmission could be explained by initial bilirubin levels and variations in newborn clinical characteristics at the commencement of treatment. This retrospective chart review of 187 newborns, who had received home phototherapy, revealed hyperbilirubinemia resolved in 162 of the cases (86.6 percent). Seventeen (9.1 percent) required readmission to the hospital. The strongest predictor of treatment duration using birthweight, feeding type, age at admission, and bilirubin level at commencement of treatment as independent variables was the age of the newborn at admission (R2 =.03) followed by the bilirubin level at commencement of treatment (R2 = 0.10). No variables showed predictive power in relation to the absolute drop in bilirubin. Furthermore, those newborns whose hyperbilirubinemia resolved and those who required readmission showed no significant differences in relation to their clinical characteristics of birthweight, bilirubin level at commencement of treatment, or age at admission. When variables of absolute drop in bilirubin, bilirubin level at the completion of treatment, duration of treatment, gestational age, and age at admission were analyzed based on feeding type (bottle vs. breast), the only significantly different characteristic was the bilirubin level at the completion of treatment (p =.034). Bilirubin levels at the completion of treatment were on the average lower for bottle-fed newborns when compared to breast-fed newborns. Results suggest that the older the newborn at admission, the shorter the treatment duration, and the higher the bilirubin level on admission, the longer the duration of treatment. Findings also suggest pediatricians tolerate higher bilirubin levels at the completion of treatment for breast-fed newborns than for bottle-fed. This study illustrates implications for nursing and medical management of hyperbilirubinemia by providing information regarding the home phototherapy population, treatment outcomes, and highlighting the need for proper follow-up, documentation, and continued research of this potential public health problem.

People with developmental disabilities are recognized as a vulnerable population and are frequently at increased risk due to their physical, social, economic and societal disparities. Despite these vulnerabilities, the regulations that govern community-based residential settings for the developmentally disabled provide little oversight with regard to home environmental health hazards such as lead, mercury, carbon monoxide, pesticides, radon and volatile organic compounds. Minimal data are available about the environmental health risks experienced by people in residential settings for the developmentally disabled and about how the behaviors and choices of support staff affect the indoor air quality in these residences. This study assessed the home characteristics, household behaviors and practices that place people with developmental disabilities at health risk from environmental hazards in their homes. Homes (N=57) run by three major service providers of residential services for the developmentally disabled in Anne Arundel County, Maryland were selected using random stratified sampling for evaluation. A survey and a home environmental assessment conducted by an observational walk-through of each home were used to assess the presence of neurotoxicants such as lead and mercury in the home, protective devices such as carbon monoxide detectors and radon testing, and the use of behaviors and practices that contribute to indoor pollution from pesticides, environmental tobacco smoke and cleaning products.;Twenty-eight homes (49%) had at least one source of carbon monoxide exposure and 21 (72%) of these homes had no carbon monoxide detector. **Carbon monoxide detectors tended to be more likely in homes with than in homes without carbon monoxide sources. Radon was a concern. Fifty-six of 57 homes were not tested for radon. In 41 of the homes basements, where carbon monoxide and radon are likely to accumulate, were used as living space for staff and developmentally disabled residents. Forty-nine homes reported professional pesticide contracts and 56 homes contained products with volatile organic compounds. Regulation and education of providers is necessary to prevent environmental health risks in this vulnerable population. More research is needed to investigate the home environmental health risks of people with developmental disabilities and their staff living in residential settings.

The purpose of this study was to examine the factors that were most predictive of hospital admission for Congestive Heart Failure (CHF) patients admitted to a large urban home care organization. The Andersen Behavioral Model of Health Services Use served as the conceptual framework for the study. A retrospective design using administrative data from the OASIS instrument investigated client characteristics measured at admission (predisposing, enabling and need) and resource utilization that were predictive of hospital admission from a home health episode. This secondary data analysis included 710 CHF patients, of whom 150 or 21% were admitted to the hospital during a home health episode. A logistic hierarchical regression was performed to determine predictors of hospital admission. Four questions were tested to determine predictors. Three measures--increase in dyspnea, fewer physical therapy visits and higher visit intensity--predicted hospital admission. Chi-square and t-tests were conducted to determine if there was a difference between those hospitalized and those not hospitalized. Patients were more likely to be hospitalized if they: had Medicaid as their primary payer; had increased shortness of breath with activity; had a higher acuity level as measured by symptom control; required more assistance in upper body dressing; needed more assistance in ambulating; had difficulty transferring; were more dependent in all Activities of Daily Living; had significantly fewer physical therapy visits; and had a higher intensity of visits per day. The findings demonstrate the value of using OASIS for a specific disease, CHF, in examining the outcome of hospitalization from a home care agency. Findings provide information for nurses on the importance of the assessment of dyspnea during the first home care visit, the use of physical therapy services and the role of the visit intensity during a home care episode. Further research needs to explore the restrictive policies of the state Medicaid programs that may contribute to the significantly higher hospitalization rates of these CHF patients.

Background. Over the last decade, methamphetamine (yabaa) has become a drug of choice for Thai youths. There were 19,253 people with substance use disorders treated at the legal treatment center in 2000. After completing the treatment program, a high percentage (80-90%) relapse to their previous drug use behavior. However, measuring the stages of change, treatment motivation, and abstinence self-efficacy among adolescents with methamphetamine use have not been studied in Thailand. Purpose. To determine whether the boot camps for Thai adolescents with yabaa use history affect their stages of change, treatment motivation, and self-efficacy for abstinence and to examine predictors of change in the stages of change, treatment motivation, and self-efficacy for abstinence. Methodology. A pretest-posttest design was conducted on Thai adolescents with yabaa use. Four hundred and thirty-eight adolescents, between 12 to 21 years of age, who entered to boot camp in Thailand answered questionnaires which consisted of four parts: (1) background information; (2) the Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES) assessing stage of change, (3) the Texas Christian University Treatment Motivation Scale (TMS) assessing motivation for treatment; and (4) the Drug Taking Confidence Questionnaire (DTCQ) assessing self-efficacy for abstinence. The entire questionnaire was translated into Thai.;Results. The findings showed that the adolescents' mean scores of Recognition and Ambivalence subscales of SOCRATES significantly decreased while the mean score of Taking Steps subscale significantly increased as a result of participation in boot camp. In addition, the boot camp also significantly increased participants' treatment motivation and self-efficacy for abstinence. Adolescents' age, education, and pressure to get rehabilitation influenced changes in stage of change and treatment motivation. Also the number of drugs used influenced changes in self-efficacy for abstinence. Moreover, there was significant variation among the study sites for the stages of change, treatment motivation, and self-efficacy for abstinence. Conclusion/implication. The results of this study will be useful for nurses and other health care providers to better assess the stage of change, treatment motivation, and the self-efficacy for abstinence before, during, and after the drug treatment program. Moreover, the results from the study could be used to help staff identify interventions that will promote movement toward behavior changes.

This cross-sectional study was conducted to examine the relationships among physiologic, well-being, and coping resource variables and their influence on functional performance in community-dwelling people with chronic obstructive pulmonary disease (COPD). The sample consisted of 119 patients (53.8% male, Mage = 68.17 +/- 8.45 years, 99.1% Caucasian). Two physiologic variables (forced expiratory volume in one second converted to a percent of a predicted value that is adjusted for height, age, gender, and race [FEV1%pred] and concomitant medical comorbidity), four well-being variables (depression, anxiety, happiness, and life satisfaction), two coping resource variables (perceived social support and mastery) and gender were proposed as predictors of functional performance. When functional performance was regressed on each proposed predictor individually (controlling for age) all except comorbidity and gender were significant predictors. However, the multiple regression of functional performance in all proposed predictors plus gender simultaneously showed that only depression (beta = -.707, p = .000), FEV1%pred (beta =.242, p =.000), gender (beta = -.189, p =.012), and the control variable of age (beta = -.322, p = .000) were significant predictors. These variables combined to explain 46% of the variance in functional performance. The low tolerance of depression (.411) indicates the possibility of multicollinearity with the other well-being and coping resource variables, although the bivariate correlations did not suggest this. Neither social support nor mastery was a mediator between depression and functional performance. Social support mediated the effects between anxiety and functional status, but mastery did not. Depressed participants reported worse functional performance than did non-depressed participants. Anxious participants reported worse functional performance than did non-anxious participants. Additional analyses showed that depression was a mediator between social support and functional performance, and between mastery and functional performance. Anxiety (beta = .253, p = .001), life satisfaction (beta = .230, p =.004), mastery (beta = -.236, p = .003), and social support (beta = -.152, p = .036) (but neither happiness nor the control variable of age) were significant predictors of depression.

The study was designed to examine the proposed antecedents and mediators of QOL of family caregivers for older stroke patients in Korea using the stress and coping model (Lazarus & Folkman, 1984). This study identified relationships between antecedent variables (caregiver, stroke patient, and environmental variables) and the caregiver QOL. Additionally, this study examined potential moderating effect of obligation, the cultural characteristic, as well as the mediating effect of perceived social support and caregiver appraisal. Using the general linear model, the caregiver QOL differences by caregiving duration were examined. A cross-sectional design was employed to examine factors that influenced QOL of Korean family caregivers of older stroke patients. The stress and coping model (Lazarus & Folkman, 1984) guided the study. Data were collected from participants at an outpatient clinic of a stroke center at three hospitals and two home health agencies located in Seoul, the capital city of Korea and its suburban area of Kyunggi-do. The questionnaire was self-administered. The Statistical Package Social Sciences (SPSS) 13.0 was used for data analyses. A total of 147 caregivers participated in this study. The mean age of caregivers for this study was 50 (SD = 14.15). Most of caregivers were female (77.6%), married (78.2%), educated greater than high school (80.9%), and unemployed (71.4%). Sixty-four caregivers (43.5%) were spouses of older stroke patients, while 81 subjects (55%) were adult children (i.e., daughter, daughter-in-law, and son). The hypothesis test revealed that 13 predictors explained 23% of the variability in caregiver QOL. Especially, weekly caregiving hour and caregiver gender were found to be significant predictors of caregiver QOL. Furthermore, perceived social support was a mediator between the antecedent variables and QOL. However, caregiver appraisal did not mediate the relationship of antecedent variables and QOL. Although there was a weak relationship between the caregiver appraisal and the caregiver QOL, the cultural characteristic--obligation level moderated the relationship between caregiver appraisal and QOL. Only in situations of high obligation, the effect of stress appraisal on QOL was buttressed in spouse caregivers. There was a difference between short-term and long-term caregivers in their QOL. Those caregivers who cared for stroke patients more than 13 months reported better QOL than those caregivers who took care of patients ≤12 months. The study results contributed to the understanding of caregiving process and the importance of examining of both mediators and moderators of the process among Korean family caregivers. The knowledge gained from this study will be used to develop culture-specific and timely caregiver interventions and social policies to directly support the Korean family caregivers and indirectly stroke patients.

Background. Workplace violence is recognized as a significant hazard in the healthcare sector but has not been studied extensively in visiting health care workers. These workers are potentially exposed to violence from clients, household members, and communities without the safety services of a "fixed" workplace. The limited data suggest that they experience risk factors including client characteristics, location, working alone, and work schedule. The prevalence of verbal violence may be as high as 37% and physical violence 19.9%. (Schulte, 1995; Barling, 2001). Purpose. Develop new measures for the study of workplace violence in the home visiting healthcare workplace using the NIOSH Organization of Work framework and the Job Demand Model. Methodology. The study was a mixed method cross-sectional design using focus groups, expert content reviewers, cognitive interviews, and a self-administered survey of home visiting health workers at four home health programs (n = 130). Three new scales were evaluated for evidence of reliability and validity using Cronbach's alpha, item analysis, CFA, and hypothesis testing. Results. Cronbach's alpha for the Home Visit Risk Scale was .77, Employer Violence Prevention Scale .87 and the Personal Safety Decision Scale .57. CFA demonstrated support for two factor solutions as follows: HVRS fit indices were chi2 = 26.08, p = .16, df = 20, GFI = .90. EVPS indices were chi2 = 36.02, p = .03, df = 22, GFI = .94. Six hypotheses were supported. The HVRS was significantly and positively associated with violence and psychological job demands and different for those who made a safety decision in the past 12 months; the EVPS was significantly associated with social support and staff perception of the OSHA Violence Prevention elements, and negatively correlated to violence. Logistic regression controlling for job type, caseload and for-profit status further supported the significance of the HVRS and EVPS with violence. Conclusions and implications. The HVRS and EVPS demonstrated preliminary evidence for reliability and validity. These scales should be utilized in a representative sample of home visiting health providers. The findings also support conceptualizing home visit risk as a psychological job demand and employer violence prevention as a social support thus demonstrating that the Job Demand model holds theoretical promise for future workplace violence research.

The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to affect people in the United States and around the world at a profound rate, with African Americans being disproportionately affected. This exploratory, descriptive, and phenomenological study explores the meaning of HIV/AIDS safe sex practices among 20 recent immigrant, Jamaican, single, heterosexual women. The study describes the participants' HIV/AIDS prevention knowledge, behaviors, practices, health-belief systems, and social and cultural factors that influence their health belief system. The Health Belief Model guided the study, and the maximum variation criterion sampling technique was used to select participants. In-depth interviews, journal entries, and field notes were utilized to collect data from participants. Findings showed that most women were aware of the devastating effect of HIV/AIDS, its modes of transmission, and some aspects of prevention. The participants' religious beliefs were deeply embedded in their health practices. Women predominantly believed that HIV/AIDS was influenced by external causes. Primarily, prayer was used by participants to deal with illnesses, and they often self-medicated or accessed alternative forms of treatment before seeking medical care. Participants in this study perceived HIV/AIDS as severe, but most women did not perceive themselves as susceptible to the disease. Perceived benefits outweighed the perceived cost of practicing HIV/AIDS preventive behavior among these women. The single most motivating factor for practicing HIV/AIDS preventive behavior was knowing someone personally with the disease. However, not many women knew anyone with the disease. Women in this study did not use condoms, and some expressed lack of condom negotiating skills with partners. They also expressed fear of losing their relationship and fear of physical or mental abuse from their significant other as barriers to using condoms. Many were not sure that their relationships were mutually monogamous, and talking about sex and sexual issues among this population is still viewed as taboo.

Background. Evidence suggests that adolescent HIV/AIDS prevention intervention has been substantially effective for preventing HIV/AIDS risk-taking behavior. However, it is not clear what specific variables related to program design and implementations have the strongest effect. Purpose. The purposes of this study were to (1) examine whether adolescent HIV/AIDS prevention intervention programs designed to change knowledge, attitudes, beliefs, self-efficacy, and behaviors have been effective and (2) to determine the relationship between program design and implementation elements and outcomes. Method. A meta-analysis was conducted to evaluate the status of these programs. A systematic review of 8 computerized databases, hand searching of 6 journals, and reference lists were undertaken for primary studies published from 1990 to 2002. To be included in the meta-analysis, primary studies had to have: (1) an experimental design, (2) the intervention designed to affect HIV/AIDS risk-taking behaviors targeting adolescent, and (3) outcome data along with details sufficient for calculation of effect size. Data on demographic characteristics of participants, intervention characteristics, methodological considerations, and information necessary for calculation of effect size were extracted independently by 3 reviewers to assess inter-rater reliability. Effect sizes and homogeneity of variance measures were calculated. A number of potential moderators then were examined. Result. A total of 28 studies met the inclusion criteria. The effect sizes for all outcomes were statistically significant. However, most of the effect sizes were small, except for knowledge. Taken collectively, the largest mean effect size is for knowledge (ES = .58, 95%CI = .42 to .72), followed by attitudes toward condoms (ES = .29, 95%CI = .14 to .43), condom use (ES = .28, 95%CI = .14 to .41),attitudes toward AIDS (ES = .26, 95%CI = .11 to .41), self-efficacy (ES = .22, 95%CI = .12 to .31), beliefs regarding condoms (ES = .16, 95%CI = .41 to .31), and beliefs regarding AIDS (ES = .12, 95%CI = .003 to .24). Participant's gender and ethnicity, setting, interventionist, and number of sessions were typical moderators explaining the results. Conclusion. The findings of this study provide state of science information that could enable policy makers to identify the overall effectiveness of these programs and can provide program designers to improve HIV/AIDS prevention programs information. This can help reduce the spread of HIV/AIDS among young people.

The purposes of this critical ethnography were to identify community health promoting strategies; to uncover the influence of power inequality on women's participation in community health promotion; and, to describe visions for change from rural Thai women perspectives. Participant observation was employed. Twenty-one women from one rural village in southern Thailand were interviewed in addition to focus groups during a six months period. Three sources of ethnographic materials were used: taped-recorded verbatim transcriptions from individual interviews and focus groups, field notes from participant observations, and journal entries. The processes of data reduction, data display, and data conclusion and verification were employed for data analysis and synthesis. Ethical issues and rigor of the study were primary considerations. Emerging themes were validated by the participants, two experts in qualitative research, and one expert in community health. The findings were translated into English and validated by three bilingual Thai faculty members. The women identified eight elements of a healthy community: good living, good eating, togetherness, unity, safe and secure environment, pollution-free environment, availability of infrastructure, and accessibility to services. Getting together, balancing power and exercising power were strategies these women employed to create a healthy community. Power inequality due to socio-economic and cultural constraints was described as both productive and oppressive influence on these women's participation in promoting a healthy community. Women in this study believed knowledge is power. They expressed the needs "to know more" and "to be known" as their vision for change. Critical ethnography facilitated the process of enlightenment, empowerment, and emancipation among study participants. Policy implications and imperatives for nursing practice and nursing research were presented. The findings provide the baseline information for planned community health empowerment program for women aggregate in rural Thailand.