Coping strategies and uncertainty in the woman with gestational diabetes

The purpose of this descriptive correlational study was to describe the level of uncertainty, the coping strategies, and the relationship between uncertainty and coping strategies for women with gestational diabetes. Snyder's (1979) holistic model of childbearing and Mishel's (1984, 1988) theory of uncertainty served as the theoretical framework for the study. A convenience sample of 46 subjects who were experiencing gestational diabetes for the first time completed the Uncertainty Stress Scale (High-Risk Pregnancy Version), the Jaloweic Coping Scale (1987), and a patient information sheet. The questionnaires to the subjects were mailed. For the majority of subjects this was their first pregnancy. The average gestational age of the subjects was 31.2 weeks. The average maternal age was 31.6 years. The majority had a family history of diabetes. Overall, the women with gestational diabetes perceived moderately low levels of uncertainty however, perceived uncertainty varied from quite low to quite high. The women also indicated that gestational diabetes was considered to be fairly serious. The nature of the uncertainty appeared to be generated primarily by concerns over the baby's health and the meaning of the diabetes for the women's pregnancy. Women who were in the 20 to 29 weeks pregnancy group perceived the most uncertainty. Women with gestational diabetes used various coping strategies to manage their uncertainty and the stress it generated. There was a tendency to use optimistic and confrontive coping strategies the most with problem-focused coping strategies being the most frequently used in dealing with the stress of gestational diabetes. Findings indicated that the patients with higher levels of uncertainty tended to use emotion-focused coping strategies such as evasive, fatalistic and self-reliant. Findings also indicated that although positive feelings may be associated with the uncertainty, positive feelings were rather low. Based on the findings of this study, implications were suggested for new directions for the provision of effective nursing care for women with gestational diabetes. It also recommended that further research is needed to identify and explore relationships between uncertainty and coping strategies, particularly as it relates over time.Applied Science, Faculty ofNursing, School ofGraduat

Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial

BACKGROUND: Exercise programs improve balance, strength and agility in elderly people and thus may prevent falls. However, specific exercise programs that might be widely used in the community and that might be “prescribed” by physicians, especially for patients with osteoporosis, have not been evaluated. We conducted a randomized controlled trial of such a program designed specifically for women with osteoporosis. METHODS: We identified women 65 to 75 years of age in whom osteoporosis had been diagnosed by dual-energy X-ray absorptiometry in our hospital between 1996 and 2000 and who were not engaged in regular weekly programs of moderate or hard exercise. Women who agreed to participate were randomly assigned to participate in a twice-weekly exercise class or to not participate in the class. We measured baseline data and, 20 weeks later, changes in static balance (by dynamic posturography), dynamic balance (by a timed figure-eight run) and knee extension strength (by dynamometry). RESULTS: Of 93 women who began the trial, 80 completed it. Before adjustment for covariates, the intervention group tended to have greater, although nonsignificant, improvements in static balance (mean difference 4.8%, 95% confidence interval [CI] –1.3% to 11.0%), dynamic balance (mean difference 3.3%, 95% CI –1.7% to 8.4%) and knee extension strength (mean difference 7.8%, 95% CI –5.4% to 21.0%). Mean crude changes in the static balance score were –0.85 (95% CI –2.91 to 1.21) for the control group and 1.40 (95% CI –0.66 to 3.46) for the intervention group. Mean crude changes in figure-eight velocity (dynamic balance) were 0.08 (95% CI 0.02 to 0.14) m/s for the control group and 0.14 (95% CI 0.08 to 0.20) m/s for the intervention group. For knee extension strength, mean changes were –0.58 (95% CI –3.02 to 1.81) kg/m for the control group and 1.03 (95% CI –1.31 to 3.34) kg/m for the intervention group. After adjustment for age, physical activity and years of estrogen use, the improvement in dynamic balance was 4.9% greater for the intervention group than for the control group (p = 0.044). After adjustment for physical activity, cognitive status and number of fractures ever, the improvement in knee extension strength was 12.8% greater for the intervention group than for the control group (p = 0.047). The intervention group also had a 6.3% greater improvement in static balance after adjustment for rheumatoid arthritis and osteoarthritis, but this difference was not significant (p = 0.06). INTERPRETATION: Relative to controls, participants in the exercise program experienced improvements in dynamic balance and strength, both important determinants of risk for falls, particularly in older women with osteoporosis