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PubMedDate not supplied

The experiences of international nursing students in a baccalaureate nursing program.

International students, especially those with English as a second language (ESL), can have difficulty adjusting to university life in the United States and successfully completing the demands of a nursing program. The purpose of this qualitative study was to explore the perceptions and experiences of international nursing students in a baccalaureate nursing program. Eight female Nigerian nursing students aged 25 to 48 who had been in the United States from 5 to 20 years were interviewed. Most (75 per cent) had some prior college experience, but only two had a baccalaureate degree. The data was analyzed by using a multifunctional computer software program and three themes emerged: social isolation, resolved attitudes, and persistence despite perceived obstacles. Factors contributing to each theme explained how these students progressed from their social isolation to their resolved attitudes. Their progression was marked by an acceptance of antagonistic attitudes found in the program and their development of persistence despite perceived obstacles. Their persistence was the impetus to achieve their overall goal of graduating from the program. Implications for nursing faculty include assisting these students through social and academic transitions and nursing administrators' provision of fiscal and support resources to facilitate effective integration of international students into the nursing program and the community.

Adult↗

PubMed1978

The social behavior of elderly aphasic versus nonaphasic long-term patients.

A study was made of the social consequences of communicative disorders among 51 elderly hospitalized long-term patients. Independent variables used to account for variations in social behavior were: 1) the presence or absence of aphasia, an impairment resulting in varying degrees of loss of verbal recognition, comprehension and language production; 2) sex; and 3) the level of nursing-care needs as an indicator of overall physical independence. A rating scale for measuring "Social Involvement" was constructed. It involved four analytically-derived factors - Interpersonal Behavior, Familial and Social Contacts, Group Participation, and Extent of Social Contacts. Since a comparison of the 15 aphasic and 36 nonaphasic subjects on the basis of these four factors revealed no substantial main effect, it would seem that social isolation was not attributable to aphasia per se. Rather, a number of significant interactions indicated that differences in the levels of social involvement were attributable to the combined influences of sex, presence or absence of aphasia, and varying levels of physical independence. The relationship between social involvement and social isolation has implications for the overall management and rehibilitation of long-term patients.

Aged↗

PubMed2007

QUALIDEM: development and evaluation of a dementia specific quality of life instrument. Scalability, reliability and internal structure.

OBJECTIVE: To develop a Quality of Life questionnaire rated by professionals that can be used for people with dementia in different stages of the disease, living in residential settings. METHOD: Development was performed in two phases: item generation and pilot testing, and a field survey to evaluate the psychometric properties. For unidimensionality we used a non-parametric model from item response theory: the Mokken scaling model, and computed the corresponding scalability coefficients, using a theory driven strategy. RESULTS: The pilot survey resulted in a list of 49 items. The field survey was performed in a sample of 238 people with dementia residing in ten nursing homes. The scalability of the subscales positive affect, negative affect, restless tense behavior, and social relations is strong (0.50 < H < 0.63); for care relationship, positive self image, feeling at home, and having something to do, scalability was moderate (0.40 < H < 0.49), and for social isolation it was weak (H = 0.34). The reliability coefficient Rho (under assumption of double monotonicity) varied from 0.60 for social isolation to 0.90 for positive affect (Cronbach's alpha varied from 0.59 to 0.89). Twenty-one of 40 items are suited for people with very severe dementia. CONCLUSION: The QUALIDEM is an easy to administer and sufficiently reliable rating scale that provides a QOL profile of persons with dementia in residential settings. The QUALIDEM can be used for evaluation as well as for research and practice innovation.

Adaptation, Psychological↗

PubMed1989

Discouraged older workers: an exploratory study.

The research literature has documented the social and psychological consequences of unemployment for individuals in our country. Unfortunately, few studies have examined the impact of unemployment on the older worker. This exploratory study examined the characteristics and experiences of seventy-three older unemployed workers, age fifty and above, who were discouraged and had stopped searching for a full-time job. The findings portray the discouraged older worker as potentially at risk of both economic and psychological difficulties. Participants reported feeling mildly depressed about their current unemployment situation, socially isolated and embarrassed, and were experiencing low life satisfaction generally. They also tended to use a low number of social and employment-related community services. Younger participants in the sample under age sixty, those with higher levels of education, and those suffering longer periods of unemployment tended to report having the greatest adjustment difficulties. These results reflect the challenges faced by the discouraged older worker and the need for targeted employment and supportive services to aid this population group.

Age Factors↗

PubMed2001

Long-term evaluation of isolation-rearing induced prepulse inhibition deficits in rats.

RATIONALE: Rats reared in social isolation from weaning show prepulse inhibition (PPI) deficits which are thought to model the sensorimotor gating deficits seen in schizophrenia and other psychiatric disorders. However, recent studies have questioned the robustness of this paradigm. OBJECTIVE: The existence of a substantial dataset generated over 4 years in our laboratory has allowed the investigation of the robustness and reliability of the procedure under a variety of environmental conditions. The effects of atypical antipsychotics (clozapine, olanzapine and risperidone) under different experimental conditions are also reported. METHOD: At weaning, Hooded Lister pups were singly (isolates) or group (n=5) housed (grouped). Eight weeks later, the startle and PPI response of isolates and grouped rats was investigated using conditions of fixed inter-stimulus interval (ISI) (pulse=110 dB/50 ms; prepulse=80 dB/30 ms; ISI=100 ms) or variable

Acoustic Stimulation↗

PubMed1994

Psychosocial outcome following severe closed head injury.

A comprehensive study of outcomes following severe head injury must clearly include an indicator of psychosocial outcome. Several studies have identified the chronic social isolation which is commonly experienced among this group of people. The present study sought to explore the availability and adequacy of social support following traumatic injury and the relationship between this and emotional distress. In an attempt to identify those sequelae which may be specific to brain trauma, the study compared a group of men with severe head injuries, and their partners, with a group of men with spinal cord injuries, and their partners (n = 60). Time since discharge ranged from 4 months to several years. All four groups reported low availability and adequacy of social integration and exhibited high levels of depression, with no relationship between depression and the length of time since discharge. No statistically significant differences were found between the groups, indicating that the social isolation which has previously been identified amongst people with head injuries may not be attributable solely to brain damage. It would also appear that the repercussions of a traumatic injury extend long after discharge from hospital and this may demonstrate a need to re-examine the provision of service to these client groups.

Adult↗

PubMed1978

The biology of social attachments: opiates alleviate separation distress.

The possibility that brain opiate systems participate in the control of social affect was assessed by determining capacity of low doses of exogenous opiates (0.125-0.50 mg/kg oxymorphone, and 0.10-0.50 mg/kg morphine sulfate) to reduce distress vocalizations of socially isolated puppies. Low doses of opiates were capable of profoundly reducing crying as well as the motor agitation they exhibit during brief periods of social isolation. Since reductions in crying could be obtained with morphine in the absence of any gross behavioral disturbances, the possibility is entertained that brain opiates may function to control the intensity of emotions arising from social separation. Possible parallels between the biological nature of narcotic addiction and the formation of social bonds are discussed.

Animals↗

PubMed1999

Family and client perspectives on alternative residential settings for persons with severe mental illness.

OBJECTIVE: The housing preferences of persons with severe mental illness living in three types of community residences were examined, as were their perceptions of problems in these settings and the relationships between clients' and family members' housing preferences and perceptions of problems. METHODS: A closed-ended questionnaire was developed to gather demographic and diagnostic data and information about housing preferences and seven categories of service-related problems. It was completed by clients who lived in group settings with 24-hour on-site staff, in supported housing with on-site visits by staff, and in homes or apartments with no on-site professional services. Questionnaires were returned by 129 family members and 180 clients. RESULTS: Clients who lived in group settings were significantly more likely to be older, less educated, unemployed, and diagnosed as having schizophrenia than clients in other settings. Although a larger proportion of family members than clients preferred housing with more support, for both families and clients a statistically significant association was found between current and preferred residence. A strong and significant correlation was found between clients' and family members' perceptions of problems, which included stress on the family and clients' social isolation and relapse to illness. For clients who lived independently, a significantly greater proportion of both clients and families reported that social isolation was a problem. CONCLUSIONS: Although supported housing works well for some individuals, a continued need exists for an array of housing with varying levels of structure. The results suggest that clients and families identify the same problems as priorities.

Adult↗

PubMed1996

[Social network and social support for married women and their spouses].

This study investigated various psychological aspects of social networks of married women and their spouses A survey data for 259 women and 185 men were analyzed, and main findings were as follows: 1. With marriage, support agents of women and men change extensively in their social networks. Wives have more variety in support agents within their social network, through children to their friends' parents. On the other hand, husbands' agents are likely to be confined to their wives and children. 2. Wives and husbands are similar in that their first choice for seeking advice is their spouse. A friend is the second choice for both of them. While parents, brothers and sisters serve as wives' third choice, there is no third for husbands. 3. Enrichment of wives' social network, based on a well-functioning relationship with husbands, leads to a lower degree of social isolation experienced by them.

Adult↗

PubMed2000

The genetic liability to stress and postweaning isolation have a competitive influence on behavioral organization in rats.

Rats housed in social isolation postweaning (isolates) show profound behavioral and neurobiological differences when compared to socially housed rats (socials). Fischer rats (F344) relative to Lewis rats are hyperresponsive and significantly more susceptible to stressful stimuli. This investigation tested the hypothesis that the behavioral effects of postweaning isolation are more pronounced in a strain of rats with high susceptibility to stress compared to a strain with low susceptibility to stress. Seventy male Sprague-Dawley, Lewis, and F344 rats were housed individually or in groups at weaning on Day 21 and tested on Day 85 in the Behavioral Pattern Monitor. There was no interaction between strain and postweaning isolation for measures of locomotor activity and exploratory behavior (holepoking). However, the postweaning isolation-induced increase in the frequency of repetitive straight movements, a measure of behavioral organization, was more pronounced in Lewis isolates compared to Sprague-Dawley and F344 isolates. These results do not support the hypothesis that rats with a higher susceptibility to stress show more pronounced changes in behavior following postweaning isolation; instead, increased susceptibility to stress may counteract the repetitive movement patterns induced by social isolation.

Animals↗

PubMed2003

The effect of social factors on the anxiolytic efficacy of buspirone in male rats, male mice, and men.

Earlier findings suggest that housing conditions in laboratory animals and life events in humans influence the efficacy of anxiolytic drugs. Here we report on the impact of social isolation on buspirone efficacy in male mice and rats as assessed by the elevated plus-maze. In addition, the impact of social support on buspirone efficacy was assessed in male patients. When administered 30 min before testing and irrespective of housing conditions, buspirone significantly suppressed locomotor activity both in mice (6 mg/kg) and rats (10 mg/kg) and, as such, other behavioral changes observed at this time point must be seen as behaviorally nonselective. However, these locomotor disruptive effects of buspirone were not evident in either species at longer injection-test intervals (2 and 4 h). When given 2 h prior to testing, a low (3 mg/kg) but not high (10 mg/kg) dose of buspirone increased the frequency of open arm exploration in rats (but not mice) irrespective of housing conditions. At the longest injection-test interval used (4 h), buspirone increased the duration of open arm exploration in individually housed, but not group-housed, rats. Similar, though somewhat less robust, effects were observed in male mice at this time. In a double-blind placebo-controlled study with male patients, chronic buspirone treatment (3 x 10 mg daily for 6 weeks) produced a highly significant reduction in scores on the Hamilton Rating Scale for Anxiety (HAM-A). Multiple regression analysis of social support received by patients indicated that the support of nonrelatives (but not of family or other relatives) was a strong positive predictor of buspirone efficacy. Taken together, our data support the hypothesis that social conditions affect the anxiolytic efficacy of buspirone. Results are discussed in relation to differences in the social organization of the three species investigated.

Aged↗

PubMed2003

Effect of isolation rearing on pre- and post-synaptic serotonergic function in the rat dorsal hippocampus.

Several behavioural, neurochemical, and structural alterations found in isolation-reared rats are similar to those in human schizophrenia. This study investigated changes in cholinergic and serotonergic function in the hippocampus following isolation rearing. Rats were reared in social isolation from weaning for 6 weeks before study and compared to group-reared rats. An in vitro electrophysiological study investigated the effect of isolation rearing on postsynaptic 5-HT(1A) function on CA1 hippocampal neurones activated with the muscarinic agonist carbachol and found no change in the sensitivity of these postsynaptic receptors between the groups. However, a change in presynaptic function was identified, as there was a significant reduction in the time taken for neuronal firing to recover to 50% of the original rate following 5-HT (10 microM) application, in isolation compared to group-reared rats. These data suggest a possible change in reuptake following isolation. Uptake studies using (3)[H]5-HT, however, found no change in the inhibition of uptake produced by either fluoxetine or paroxetine in isolation compared to group-reared rats. The selective 5-HT(1B) antagonist CP-294253 (1 microM), increased endogenous 5-HT release from hippocampal slices in vitro and this effect was greater (P < 0.001) in group compared to isolation-reared rats. These results indicate that the change in presynaptic 5-HT neuronal function was due to impaired autoreceptor responsiveness. Carbachol (1 microM) increased the firing rate of all neurones recorded but only a proportion of these showed a concentration-related increase. Isolation rearing increased the sensitivity of neurones, showing a concentration-related increase in firing in response to carbachol, but had no effect on the other neurones. In summary, the present study showed that isolation rearing alters presynaptic 5-HT(1B) but not postsynaptic 5-HT(1A) receptor activity in the hippocampus. Isolation rearing in the rat results in hippocampal dysfunction, including reduced serotonergic and enhanced muscarinic activity of some neurones. These effects may in part underlie the behavioural consequences of isolation relevant to human developmental disorders.

8-Hydroxy-2-(di-n-propylamino)tetralin↗

PubMedDate not supplied

Accidental hypothermia in the sunbelt.

Hypothermia in colder climates in the United States occurs predominately as a result of exposure of alcoholics to cold outdoor temperatures. Among 24 cases of accidental hypothermia occurring at a university medical center in the deep South, differences in clinical presentation were identified. In contrast to experience in colder climates, 17/22 cases (76%) developed at home. Alcohol was a factor in only 8/24 (33%). The elderly were at greatest risk, accounting for 16/24 patients (65%). Factors suggested to account for the high incidence of hypothermia in the elderly include abnormal temperature perception or regulation, intercurrent illness, social isolation, inadequate housing, and poverty. Coexisting medical conditions were identified as a potential cause of hypothermia in only 10/24 of these patients (42%). Social isolation was not a strong predictor, with 6/17 of the elderly (35%) living alone. Death occurred in 9/24 patients (37%), but survival could not be predicted from admission temperature, hypotension, anemia, or serum glucose. Since extreme cold temperatures are infrequent in the deep South, identified differences in demographics may be due to inadequate housing or lack of preparation for cold weather dangers.

Accidents↗

PubMed2003

Morbidity, mortality, and quality-of-life outcomes of patients requiring >or=14 days of mechanical ventilation.

OBJECTIVE: To determine the outcome and health-related quality of life of patients requiring >or=14 days of mechanical ventilation in the intensive care unit (ICU). DESIGN: Prospective cohort study with post-ICU, cross-sectional, health-related quality-of-life survey. SETTING: A 17-bed ICU in a university hospital. PATIENTS: A consecutive cohort of 347 patients receiving mechanical ventilation for >or=14 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the patients enrolled in the study, 150 (44%) died in the ICU and 197 were discharged (58 of 197 died 1-57 months after discharge). Factors associated with ICU death according to multivariate logistic regression analysis were age >or=65 yrs, preadmission New York Heart Association functional class of >or=3, a preadmission immunocompromised status, septic shock at ICU admission, renal replacement therapy in the ICU, and nosocomial septicemia. Cox proportional hazards multivariate analysis identified age of >or=65, a preadmission immunocompromised status, and duration of mechanical ventilation for >35 days as independent predictors of death after ICU discharge. By contrast, postcardiac surgery patients had a better outcome. Health-related quality of life was evaluated for 87 of the 99 long-term survivors after a median follow-up of 3 yrs by using the Nottingham Health Profile and St. George's Respiratory questionnaires. Compared with those of a general French population, their scores were significantly worse for each of the Nottingham Health Profile domains, except social isolation. Nottingham Health Profile scores did not significantly differ between postcardiac and nonpostcardiac surgery patients, men and women (except that women felt more socially isolated), and patients with and without acute respiratory distress syndrome (except for more sleep disorders in those with acute respiratory distress syndrome). Finally, pulmonary-specific St. George's Respiratory Questionnaire global score was worse for acute respiratory distress syndrome survivors. CONCLUSIONS: Prolonged mechanical ventilation is associated with impaired health-related quality of life compared with that of a matched general population. Despite these handicaps, 99% of the patients evaluated were independent and living at home 3 yrs after ICU discharge. Future studies should focus on physical or psychosocial rehabilitation that could lead to improved management of patients after their ICU stay.

Activities of Daily Living↗

PubMed1986

Visually imprinted maternal preference in ducklings is redirected by social interaction with siblings.

This study examined the influence of social interaction with broodmates on a visually imprinted maternal preference in domestic mallard ducklings (Anas platyrhynchos) during the first three days of postnatal life. Twenty-four-hour-old ducklings were allowed to follow a stuffed mallard hen for 30 min. This experience resulted in a visually imprinted preference for the familiar stuffed hen over 4 stuffed ducklings in simultaneous choice tests at 48 and 72 hr after hatching, but only if the imprinted birds were kept in social isolation. Imprinted ducklings reared in a social group containing either same-age siblings or the stuffed mallard hen and same-age siblings displayed a visual preference for the stuffed ducklings over the familiar mallard hen at 48 and 72 hr tests. As a first step in the analysis of the features of the social exposure to siblings that are necessary for the redirection of the visually imprinted maternal preference, it was found that direct social interaction is essential to establish the preference for ducklings, but even mere visual exposure to siblings does away with the imprinted maternal preference. These results provide striking evidence of the ready redirection of a species-specific maternal preference in otherwise imprinted ducklings.

Animals↗

PubMed1996

Health-related quality of life among the least dependent institutional elderly compared with the non-institutional elderly population.

The purpose of this study was to investigate health-related quality of life (HRQOL) and functional ability among the least dependent elderly in residential care, and to compare them with information on the general population. A stratified systematic sample (n = 1,587) was drawn from a one-day census of patients in all public residential homes in Finland on December 2, 1991. Sixty-nine per cent of residents in 1992 were able to participate (n = 1,097) and 86% of them returned the questionnaire (n = 948), of which n = 795 were acceptable, the response rate being 72%. A postal survey was used for data collection. The personnel of residential homes were allowed to help residents complete the questionnaire, and 90% of respondents received such help. HRQOL was measured by the Nottingham Health Profile (NHP) and functional ability by a 14-item questionnaire. Finnish studies among the general population were used for comparisons. According to the NHP, the HRQOL appeared lower in institutional care and this was associated with the dependency level. Similarly, for most ADL items the general population had less restrictions than the least dependent residential care patients. In general, women expressed more difficulties in physical mobility and lack of energy than men. The longest stay elderly expressed better HRQOL. In multivariate models adjusted for age and gender those with poor vision had worse HRQOL in almost every dimension of NHP. Difficulties in speech were connected with emotional reactions and social isolation. Chronic illness limiting normal daily life predicted more problems in energy, pain, physical mobility, and emotional reactions. The married or widowed experienced less social isolation than single elderly. Higher education was related to better HRQOL in all NHP dimensions. Poorer perceived health was associated with lack of energy, pain, and emotional reactions. We conclude from these results that there are only a few clients in residential care whose HRQOL or functional ability compare with the non-institutionalized population.

Activities of Daily Living↗

PubMed1985

Living with an amputation: the helper.

One hundred and nine key helpers were interviewed in connection with a study of the psychosocial implications of amputation. They were found to carry formidable burdens. Social isolation was a major problem which increased over time and was associated with diminished capacity to express needs. The respondents discussed emotional problems readily. Social workers had little sustained contact with helpers: welfare agencies had intervened mainly to provide practical help. The Artificial Limb Centre did not routinely see helpers or communicate with General Practitioners. A more realistic approach to the support of those who implement community care policies is advocated, with particular reference to the need for respite care to be provided in the domestic setting. The dangers of the exploitation of women as carers are highlighted.

Adaptation, Psychological↗

PubMed1993

Alcohol use and abuse in the frail, homebound elderly: a clinical analysis of 103 persons.

We studied alcohol use and abuse in 103 frail, homebound elderly individuals cared for in a long-term home health care program from July 1991 to February 1992. Their average age was 80.63 years. Eighty-four percent were abstinent at the time of the study, including 25 (25%) past heavy drinkers. Two persons were current heavy drinkers and 14 continued to drink socially. Previous alcohol use or abuse was associated with a history of smoking, cardiovascular morbidity, social isolation, and anxiety or agitation. Current social drinking was associated with sedative-hypnotic use as well as smoking. Twenty-three of 25 past heavy drinkers remained sober on our programs without the use of formal alcohol treatment. Abstinence is known to increase with age, appears to be fostered by the homebound setting, is feasible for homebound elderly persons and is often accepted.

Aged↗