The Effects of Nursing Back Rub on Pain and Wound Cytokines and The Relationship Between Pre-CABG Mood and Post-CABG Wound Cytokines

This study, guided by psychoneuroimmunology theory, examined the effects of a 10-minute nursing back rub in 20 coronary artery bypass graft (CABG) patients on pain and four proinflammatory wound cytokines (IL-1β, IL-6, IL-8, and TNF-α). It also examined the relationships between the Profile of Mood States (POMS) and the proinflammatory cytokines. A control group (n = 8) received time with the researcher, and an experimental group (n = 12) received a slow stroke effleurage back rub. All participants initially completed the POMS and after surgery, wound fluid was collected from the mediastinal chest tube before and after the intervention. Analysis showed the experimental group had a significant decrease in pain (df 11, p=0.001). Pretest mean levels of cytokines one hour before the back rub were: IL-1β, 15.1 pg/ml; IL-6, 104,680pg/ml; IL-8, 6,953 pg/m, and TNF-α, 3.5 pg/ml. Posttest cytokine mean levels were: IL-1β, 13.71 pg/ml; IL-6, 94,658.5 pg/ml; IL-8, 22,431 pg/ml; and TNF-α, 3.6 pg/ml. There were no significant changes in any cytokine levels in either group from pretest to posttest. Great variability in cytokine concentrations was noted in both the experimental and the control group. No significant relationships were found between the POMS Total Mood Disturbance Score (TMDS) and cytokine levels. There was a significant inverse relationship (r = -.560, p=.016) between the POMS score of tension-anxiety and IL-6. There was a significant positive correlation (r = .475, p=.034) between IL1-β and weight. This study has contributed support to a nursing intervention that appears to reduce pain perception, to the understanding of wound cytokine levels in CABG patients, and to psychoneuroimmunology research in that wound fluid IL-6 levels in were lower in patients who were tense/anxious before surgery. Further research needs to be done on wound healing and stress reducing interventions

Motivating Persons with Schizophrenia to Exercise: Rationale and Design

Persons with schizophrenia spectrum disorders (SSDs) are not only at risk because of disabling disease symptoms but because necessary medications create health risks associated with high rates of obesity. Despite the well-known benefits of exercise, persons with SSDs rarely adhere to such regimens; few interventions to motivate exercise behavior have been tested in this group. The purpose of this study is to examine effects of the Walk, Address sensations, Learn about exercise, Cue exercise behavior for persons with SSDs (WALC-S) motivational intervention upon exercise behavior. We will recruit a total of eighty outpatients 18–68 years, meeting these criteria: 1) chart diagnosis of schizophrenia, any subtype, schizoaffective disorder or schizophreniform disorder, according to the criteria described in the Diagnostic and Statistical Manual for Mental Disorders, 2) English speaking, 3) Stable medication regimen (defined as no medication changes within the last month), and 4) medical clearance for moderate exercise in writing from primary care provider. Participants will be randomly assigned to the experimental (4-week WALC-S motivational intervention), or the control group (4-week time and attention control). After the first 4 weeks, all participants will attend a 16-week walking group. The primary measures of the effectiveness of the WALC-S are attendance, persistence and compliance to the 16-week walking group. The study will be completed in approximately January 2010. In addition to hypothesis testing, this study will provide information to estimate effect sizes to calculate power and determine appropriate sample sizes for future inquiries. This paper describes the rationale and design of the study

Can participatory emissions budgeting help local authorities to tackle climate change?

A lack of concerted action on the part of local authorities and their citizens to respond to climate change is argued to arise partly from a poor relationship between the two. Meanwhile, local authorities could have a significant impact on community-wide levels of greenhouse gas emissions because of their influence over many other actors, but have had limited success with orthodox voluntary behaviour change methods and hold back from stricter behaviour change interventions. Citizen participation may offer an effective means of improving understanding between citizens and government concerning climate change and, because it is inherently a dialogue, avoids many of the pitfalls of more orthodox attempts to effect behaviour change. Participatory budgeting is a form of citizen participation which seems well suited to the task in being quantitative, drawing a diverse audience and, when successfully run, engendering confidence amongst authority stakeholders. A variant of it, participatory emissions budgeting, would introduce the issue of climate change in a way that required citizens to trade off greenhouse gas emissions with wider policy goals. It may help citizens to appreciate the nature of the challenge and the role of local government in responding; this may in turn provide authority stakeholders with increased confidence in the scope to implement pro-environmental agendas without meeting significant resistance

Feasibility of the Walk, Address, Learn and Cue (WALC) Intervention for Schizophrenia Spectrum Disorders

The WALC intervention was designed to motivate exercise in the elderly. Persons with schizophrenia spectrum disorders (SSDs) face similar exercise barriers. We described theoritical underpinnings of the WALC intervention and how we adapted it for SSDs. We conducted a feasibility study of the adapted intervention in 17 persons with SSDs. The adapted intervention incorporated low intensity stretches, exercise education and exercise cues. The intervention was feasible and acceptable to participants; approximately two-thirds of all groups were attended and nearly half of participants attended at least 75% of groups. Follow up studies should examine the effect of the intervention upon future exercise behavior, with the goal of identifying evidence based interventions to increase exercise in this group

Examining Informed Consent in Persons with Schizophrenia

This descriptive study examined the responses of outpatients with schizophrenia to a tool designed to measure comprehension before obtaining informed consent to participate in a research study. We used the Evaluation to Sign Consent (ESC) form to document comprehension in 29 schizophrenia outpatients. Participants living in supervised housing were significantly more likely to require prompts than those living alone (χ2 = 9.4, p = 0.024). Participants prescribed two antipsychotic medications were significantly more likely to require a prompt than those prescribed only one antipsychotic (χ2 = 5.12, p = 0.023). Nurse researchers should consider documenting comprehension with the ESC due to its availability, time efficiency, and utility

Telenursing Intervention Increases Psychiatric Medication Adherence in Schizophrenia Outpatients

BACKGROUND: Promoting medication adherence is a critical issue in optimizing both physical and mental health in persons with schizophrenia. Average antipsychotic medication adherence is only 50%; few studies have examined nonpsychiatric medication adherence. Psychosocial interventions with components of problem solving and motivation have shown promise in improving adherence behaviors. OBJECTIVES: This study examines telephone intervention problem solving (TIPS) for outpatients with schizophrenia. TIPS is a weekly, provider-initiated, proactive telenursing intervention designed to help persons with schizophrenia respond to a variety of problems, including adherence problems. STUDY DESIGN : The authors completed objective measures of adherence to psychiatric and nonpsychiatric medications in 29 community-dwelling persons with schizophrenia, monthly for 3 months. STUDY RESULTS : Persons receiving TIPS had significantly higher objective adherence to psychiatric medications throughout the study period, F(1, 20) = 5.47, p = .0298. CONCLUSIONS: Clinicians should consider using TIPS as an adjunct to face-to-face appointments to support adherence in persons at risk

Power dynamics in multi–stakeholder policy processes and intra–civil society networking

The Handbook of Global Media and Communication Policy offers insights into the boundaries of this field of study, assesses why it is important, who is affected, and with what political, economic, social and cultural consequences. Contributors draw on theory and empirical research to offer multiple perspectives on the local, national, regional and global forums in which policy debate occurs. Policy is understood as an emergent process, informed by historical context, power dynamics, and local/global interdependencies