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Biomedical subjects

Mary E Duffy

Publications and source records attributed to Mary E Duffy.

At least 19 recordsLinked to original sources
PubMed2005

The relationship of maternal attributes, resources, and perceptions of postpartum experiences to depression.

The relationships of maternal attributes, resources, and perceptions of the postpartum experience to postpartum depression (PPD) were examined. One hundred and forty-three mothers completed measures of maternal attributes, resources, and perceptions of the postpartum experience, as well as depressed mood and clinical depression symptoms. Results from canonical correlation analysis revealed two patterns. Pattern 1: Women without history of depression, more emotional support from partners, higher parenting evaluation, lower centrality of the infant in the mother's thoughts and actions, and fewer life changes had lower depressed mood and fewer clinical depression symptoms than their counterparts. Pattern 2: Mothers without history of depression who were married, with higher financial stress, and lower parenting evaluation had higher depressed mood, but not more clinical depression symptoms. Maternal age, parity, time since delivery, income, and help from partner were unrelated to either depression indicator. These patterns suggest multiple paths to PPD, and the need for routine mental health assessment and exploration of women's perceptions of their postpartum experience.

Adolescent↗
PubMed2005

Design and psychometric evaluation of the Psychological Adaptation to Genetic Information Scale.

PURPOSE: To develop and psychometrically evaluate the Psychological Adaptation to Genetic Information Scale (PAGIS). DESIGN: A cross-sectional, Web-based survey of participants (n=323) recruited via Internet electronic mailing lists or Websites for people affected by genetic diseases. METHODS: Item analysis, confirmatory principal components analysis, and internal consistency reliability using Cronbach's alpha were used to construct the 26-item PAGIS. FINDINGS: Five factors (nonintrusiveness, support, self-worth, certainty, and self-efficacy) explained 57.7% of the variance in psychological adaptation to genetic information. The internal consistency reliability of the total PAGIS was .90, and the subscale reliabilities ranged from .77 to .87. CONCLUSIONS: Psychological adaptation to genetic information is a multidimensional phenomenon comprised of nonintrusiveness, support, self-worth, certainty, and self-efficacy. The PAGIS has initial reliability and validity for use in future research.

Adaptation, Psychological↗
PubMed2004

Correlation of postpercutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality.

Creatine kinase-MB (CK-MB) and troponin I elevations after successful percutaneous coronary intervention (PCI) are common, and different gradations have been correlated with mortality. To establish which of these 2 markers of myonecrosis, CK-MB and troponin I, accurately predicts mortality after successful PCI, we analyzed 2,873 patients without acute myocardial infarction who underwent PCI for in-hospital events and mid-term mortality. Patients were stratified into 4 groups based on peak post-PCI cardiac markers values: group I: normal CK-MB (<16 U/L) or troponin I (<2 ng/ml); group II: CK-MB or troponin I levels 1 to 3 times normal; group III: >3 to 5 times normal; and group IV: >5 times normal. CK-MB elevation occurred in 16.1% of patients, with 12.2%, 2.3%, and 1.6% in groups II to IV, respectively. Troponin I elevation was detected in 38.9% of patients, with 16.4%, 8.4%, and 14.1% in groups II to IV, respectively. There was poor correlation between postprocedural CK-MB and troponin I values (r = 0.10) and in their individual subgroups. Kaplan-Meier estimates of death for postprocedure CK-MB were 2.1%, 2.7%, 1.7%, and 10.3% (p = 0.002) for groups I to IV, respectively; for troponin I, these estimates were 2.2%, 2.3%, 2.9%, and 2.1% for groups I to IV, respectively (p = 0.58). A Cox proportional hazards model showed that CK-MB >5 times normal was the strongest predictor of mortality (hazard ratio 6.7, 95% confidence interval 1.9 to 22.9; p = 0.002), although heart failure, peripheral vascular disease, pre-PCI digoxin therapy, and post-PCI renal failure also predicted mortality. However, neither troponin I peak elevation nor any subgroup predicted mortality. Troponin I is frequently elevated after PCI, but does not predict mortality. Periprocedural CK-MB elevation >5 times normal remains an independent predictor of mid-term mortality and a valuable marker for PCI prognosis in low-to-medium risk patients.

Aged↗
PubMed2004

Development and psychometric evaluation of the Professional Practice Environment (PPE) scale.

PURPOSE: To describe the Professional Practice Environment (PPE) scale, its conceptual development and psychometric evaluation, and its uses in measuring eight characteristics of the professional practice environment in an acute care setting. DESIGN AND METHODS: The 38-item PPE Scale was validated on a sample of 849 professional practice staff at the Massachusetts General Hospital in Boston. Psychometric analysis included: item analysis, principal components analysis (PCA) with varimax rotation and Kaiser normalization, and internal consistency reliability using Cronbach's alpha coefficient. FINDINGS: Eight components were shown, confirming the original conceptually derived model's structure and accounting for 61% of explained variance. Cronbach's alpha coefficients for the eight PPE subscales ranged from .78 to .88. CONCLUSIONS: Findings showed the 38-item PPE Scale was reliable and valid for use in health outcomes research to examine the professional practice environment of staff working in acute care settings.

Acute Disease↗
PubMed2004

Video breast health kits: testing a cancer education innovation in older high-risk populations.

BACKGROUND: The Breast Health Kit for Women Over 60 project was a 3-year study funded by NCI to develop and field test video self-instruction programs designed to increase breast cancer screening for older black and white women. METHODS: Impact of kit use on knowledge about breast cancer risk/screening, breast self-examination (BSE) proficiency, and mammography use was assessed with 439 women in Massachusetts and Georgia. BSE proficiency was measured by demonstration of inspection/palpation skills and detection of lumps in a simulation model. Analysis with a noncompliant mammography user subsample (N = 143) tested the effectiveness of kit use on mammography screening. The sample was predominantly black (76%) with mean age of 71.6 years and mean education of 10.6 years. RESULTS: Analyses of covariance revealed that women who used the kits had significantly better knowledge about breast cancer risk/screening (F = 23.6, P < or =.001) and were more proficient at BSE than kit nonusers as measured by both skills (F = 47.9, P < or =.001) and detection of lumps (F = 36.8, P < or =.001). No significant differences were found between subsample groups in receiving a poststudy mammogram, but a trend toward having mammograms was noted in the subsample who used the kits (chi(2) = 1.7, P < =.09). CONCLUSIONS: Age and ethnically sensitive self-instructional breast health kits were found to be effective in increasing knowledge about breast cancer risk and BSE proficiency in older women. Future research is needed to explore how other strategies combined with kit use can assure mammography compliance in this population.

Age Factors↗
PubMed2003

Prediction of outcome after percutaneous coronary intervention for the acute coronary syndrome.

BACKGROUND: The seven-component Thrombolysis In Myocardial Infarction (TIMI) score has been used to risk stratify, and to guide the medical management of, patients with unstable angina or non-ST-elevation myocardial infarction. We assessed the usefulness of the risk score in predicting in-hospital and 30-day outcomes in such patients who were undergoing percutaneous coronary intervention. METHODS: Using the TIMI score, 2501 patients with unstable angina or non-ST-elevation myocardial infarction were divided into low-risk (zero to two risk factors; n = 974), intermediate-risk (three to four risk factors; n = 1339), and high-risk (five to seven risk factors; n = 188) groups, and outcomes were compared. RESULTS: Angiographic/clinical success and the rate of minor procedural events were similar among the three groups. A higher TIMI risk score was associated with more cardiac comorbid conditions and more complicated angiographic lesions: longer lesions (P = 0.0009), more thrombotic lesions (P = 0.03), more multivessel disease (P <0.0001), and more American College of Cardiology/American Heart Association type B2/C lesions (P = 0.05). Although the risk score did not predict interventional technical success or intraprocedural complications, a high score was associated with prolonged hospital stay, higher postprocedural peak troponin levels, and 30-day major adverse cardiac events. Stepwise logistic regression showed that in conjunction with lesion length and patient sex, a high score was an independent predictor of 30-day major adverse cardiac events (odds ratio = 2.3; 95% confidence interval: 1.1 to 4.1; C statistic = 0.62). CONCLUSION: Although a higher TIMI risk score in patients with unstable angina or non-ST-elevation myocardial infarction who were undergoing percutaneous coronary intervention correlated with adverse clinical outcome, the score alone cannot be used to guide diagnostic or therapeutic strategies.

Acute Disease↗
PubMed2003

Postprocedure chest pain after coronary stenting: implications on clinical restenosis.

OBJECTIVES: The goal of this study was to analyze the incidence and predictors of postprocedure chest pain (PPCP) after percutaneous coronary intervention (PCI) and its correlation with clinical restenosis. BACKGROUND: Chest pain after PCI occurs frequently even in the absence of procedural events and is considered to be due to vasospasm or coronary artery stretch. The short- and long-term significance of PPCP after otherwise successful stenting is not clear. METHODS: We analyzed 1,362 patients undergoing coronary stenting for PPCP, procedural and in-hospital events, 30-day major adverse cardiac events, and target vessel revascularization (TVR) at 6 to 9 months. RESULTS: There were 488 patients with PPCP and, of these, 312 patients were excluded due to procedural events. The remaining 176 patients with PPCP were compared with 874 patients without PPCP. Creatine kinase-MB isoenzyme elevation occurred in 25.6% of the PPCP group versus 9.6% of the no PPCP group (p < 0.001). Despite similar reference vessel diameter, the PPCP group had larger postprocedure minimum lumen diameter, higher stent-to-vessel ratio, and higher inflation pressure versus the no PPCP group (p < 0.01). At 30 days, the emergency room visits and repeat catheterization (16% vs. 2.7%; p < 0.001) were higher in the PPCP group versus the no PPCP group, but repeat intervention was similar. At 6- to 9-month follow-up, the TVR was significantly higher in the PPCP group compared with the no PPCP group (29.5% vs. 16.6%; p < 0.01). CONCLUSIONS: Our analysis suggests micromyonecrosis and vessel stretch as causes of PPCP. Postprocedure chest pain is associated with similar short-term outcome as no PPCP, but has higher restenosis, perhaps mediated by deep vessel wall injury. Therefore, PPCP may identify patients at high risk for restenosis.

Aged↗
PubMed2003

Institutional issues in the implementation of an international student exchange program.

This article discusses institutional issues related to the development and implementation of an undergraduate student exchange program in nursing. A consortium of four universities in the United States and six nursing schools in three European countries developed an exchange program to teach a common community health module. Thirty-one students from the United States and 30 students from Europe participated in this program, which was funded by the U.S. Department of Education and the European Union. The project commenced with a 3-week meeting of faculty and students to design the 8-week exchange program and cultural preparation module. This article describes institutional issues related to the project. Academic issues, nonacademic issues, and exchange procedures are presented. The extended meeting of faculty and students that occurred early in the funding period was critical to this program's success.

Curriculum↗
PubMed2002

Methodological issues in Web-based research.

PURPOSE: To examine methodological issues associated with using the Internet and World Wide Web for scientific research, namely, issues related to the nature of the sample, the testing environment and environmental factors, privacy, and confidentiality, and response rates. METHODS: Reviews of literature and personal observation and experience. FINDINGS: Web-based research provides many advantages such as access to specific, sometimes difficult-to-find populations, speed of data access, and decreased costs for data collection and data entry. Such benefits are likely to increase as more nurse scientists use the Web for research purposes. CONCLUSIONS: Nurse researchers who use this technology must consider the methodological problems associated with Web-based methods. The research potential exists, but the methodological issues discussed in this paper are real and, if not addressed, they can seriously affect the validity of study findings.

Internet↗
PubMed2002

The effect of an educational intervention on promoting breast self-examination in older African American and Caucasian women.

PURPOSE/OBJECTIVES: To test the efficacy of innovative, age- and race-sensitive, self-monitored, video breast health kits in increasing knowledge about breast cancer risk and screening and breast self-examination (BSE) proficiency. DESIGN: Quasi-experimental pretest and post-test design. SETTING: Dual-site study in community-based settings in the Northeast and Southeast United States. SAMPLE: 328 women (206 in the intervention group, 122 in the control group) aged 60 or older; predominantly African American (77%); mean education of 10.8 years; annual income below $10,000 (50%). METHODS: Individual pretest and post-test interviews conducted by nurses at two-week intervals assessed knowledge about breast cancer risk and screening and BSE proficiency as demonstrated on vested breast models. Intervention subjects used video breast health kits in ethnic editions designed for the study. Control subjects received educational pamphlets. MAIN RESEARCH VARIABLES: Dependent variables were knowledge about breast health and BSE proficiency measured by demonstration of inspection and palpation skills and detection of lumps in a simulation model. FINDINGS: Three multiple analyses of covariance revealed statistically significant differences in outcome variables between the intervention and control groups. CONCLUSIONS: The intervention was effective in increasing knowledge about breast cancer risk and screening and BSE proficiency in this sample of older women. IMPLICATIONS FOR NURSING: These and other educational interventions designed specifically for age and race sensitivity may enhance cancer screening with vulnerable populations. Future studies with more diverse multicultural groups are needed to improve understanding of how to best influence breast health behaviors of older women.

Black or African American↗
PubMedDate not supplied

Caregiver competence to prevent home injury to the care recipient with dementia.

Home safety is a major concern for persons with a progressive dementia, such as Alzheimer's disease, because much direct care is provided in the home setting. This study used the Home Safety/Injury Model as a frame work to describe the domain of caregiver competence, one of the model's key constructs. Interview data from the perspectives of 17 informants yielded a total of 68 clinical situations that allowed exploration of the scope and dimensions of caregiver competence to prevent accidents in the home. The factors most influential for effective caregiver prevention of home injury were family support, an acceptance and ability to make role changes, teaching and role modeling from professionals, and long-standing values and family traditions. No single factor was sufficient to achieve effective caregiving for making the home safer, but the strength of one or two factors could compensate for the absence of others.

Accidents, Home↗
PubMedDate not supplied

Health insurance for type 1 diabetes mellitus: US competition and French coverage.

Chronic diseases present a major challenge to individuals, health professionals, and policy makers. Disease burdens and fears of a lifelong condition are complicated by the volatility of health insurance. Individuals with type 1 diabetes mellitus face these challenges daily. Treatment needs persist despite changes in individual health insurance or health plan coverage, yet this costly and devastating disease does not discriminate economically. The demands for care are the same for the under- and uninsured as they are for the fully insured. As life expectancy lengthens for individuals with type 1 diabetes mellitus, a greater potential exists for significant variability in coverage. This article presents a review and analysis of health insurance issues among adults 18-64 years old and extrapolates the consequences for those in the United States (US) with type 1 diabetes mellitus. Comparisons are made with the French health care system, ranked 1st by the World Health Organization in 2000.

Diabetes Mellitus, Type 1↗
PubMedDate not supplied

Women's reflections on divorce-- 10 years later.

Ten years after divorce 95 women who participated in an earlier study of divorce were asked to reflect on their lives since their divorce. They were mailed a questionnaire to describe demographic data, self-esteem, control, life assessment, and their lives since divorce. Fewer than half remarried and of those who did, 10 divorced a second time. Slightly more women partnered than married. Their overall assessment of their lives was reported positively. However, 25% felt the same or worse than they had 10 years earlier. Income was the only demographic variable correlated with self-esteem, control, and life assessment. Women used a variety of self-care actions to improve their lives and only six women went to professional therapy. Their lives and some of the actions taken are described.

Adult↗