When they drink too much. Nursing interventions for patients with disordered water balance

Disordered water balance affects as many as 60% of severely psychiatrically disabled persons. Most patients do not progress to the point of a medical emergency, but are in a state of mild chronic intoxication, making them unavailable for treatment and requiring nursing care to treat the effects of the chronic intoxicated state. Interventions depend on the severity of the disordered water balance and vary from teaching fluid intake control to controlling all patient access to fluids. Nursing management of water intoxication is a trial and error approach. Through a thorough assessment and close observation of the patient, the nurse can determine which interventions would be most appropriate for the patient.     

Target weight procedure: preventing water intoxication.

1. Prevention of water intoxication depends on early intervention for polydipsic patients who seem to be retaining fluid. The Target Weight Procedure is designed to detect early signs of fluid retention by means of weight gain and low sodium levels. 2. The use of this protocol, in addition to successfully decreasing the number of acute water intoxication episodes, has also led to increased awareness of the meaning of patient behavior, an increased sense of control of patients with water intoxication over their behavior, and an increased feeling of competence among the staff. 3. The success of the protocol seems to be based on its purpose of identifying patients at risk and those with an impending episode, as well as secondary advantages, for example, giving the patients the option to alter their behavior to be removed from the protocol.     

Early detection of water intoxication.

1. It has been estimated that between 3% and 6% of patients in psychiatric treatment settings are affected by water intoxication. Water intoxication with consequent hyponatremia can result in disturbing clinical conditions. 2. Early detection is an important factor because of the insidious nature and rapid development of this syndrome. 3. A risk analysis for the early detection of this serious condition has been developed. It is easily administered and effective in categorizing a patient's level of risk.     

Blinking During and After Lying

We tested the hypothesis derived from eye blink literature that when liars experience cognitive demand, their lies would be associated with a decrease in eye blinks, directly followed by an increase in eye blinks when the demand has ceased after the lie is told. A total of 13 liars and 13 truth tellers lied or told the truth in a target period; liars and truth tellers both told the truth in two baseline periods. Their eye blinks during the target and baseline periods and directly after the target period (target offset period) were recorded. The predicted pattern (compared to the baseline periods, a decrease in eye blinks during the target period and an increase in eye blinks during the target offset period) was found in liars and was strikingly different from the pattern obtained in truth tellers. They showed an increase in eye blinks during the target period compared to the baseline periods, whereas their pattern of eye blinks in the target offset period did not differ from baseline periods. The implications for lie detection are discussed.     

Hitting the Skids: Social Policy and the Control of Public Intoxication

Abstract

Attempts by policymakers to control public intoxication have brought only marginal success. Through an analysis of previous control models and an examination of the specific target concerns this paper endeavors to shed light upon recent public health policies affecting public intoxication control Implications of this public health model of control as applied to this particular form of deviant behavior, are discussed.     

Early weight loss predicts the reduction of obesity in men with erectile dysfunction and hypogonadism undergoing long-term testosterone replacement therapy

We and others have previously shown that testosterone replacement therapy (TRT) results in sustained weight loss in the majority of middle-aged hypogonadal men. Previously, however, a small proportion failed to lose at least 5% of their baseline weight. The reason for this is not yet understood. In the present study, we sought to identify early indicators that may predict successful long-term weight loss, defined as a reduction of at least 5% of total body weight relative to baseline weight (T0), in men with hypogonadism undergoing TRT. Eight parameters measured were assessed as potential predictors of sustained weight loss: loss of 3% or more of baseline weight after 1 year of TU treatment, severe hypogonadism, BMI, waist circumference, International Prostate Symptom Score (IPSS), glycated hemoglobin (HbA_1C), age and use of vardenafil. Among the eight measured parameters, three factors were significantly associated with sustained weight loss over the entire period of TU treatment: (1) a loss of 3% of the baseline body weight after 1 year of TRT; (2) baseline BMI over 30; and (3) a waist circumference >102?cm. Age was not a predictor of weight loss.     

Selected health behaviors that influence college freshman weight change

OBJECTIVE AND PARTICIPANTS: The authors investigated the effect of physical activity (PA), fruit and vegetable intake, and alcohol use on 6-month weight change in 193 college freshmen (78.8% white, 88.2% women, 94.5% on a meal plan). METHODS: The authors administered a Web-based survey in fall 2002 (baseline) and spring 2003 (follow-up). RESULTS: There was an overall average weight gain of 2.5 lbs (p < .05), although only 57% reported weight gain (M = 7.1 lbs). Fruit and vegetable intake decreased (p = .034), alcohol use increased (p > .05), and PA was unchanged. Weight gain for students with body mass indexes (BMI) > or =25 kg/m2 was nearly twice that of students with BMIs < 25 (p < .05). Students with low-frequency baseline PA were twice as likely to be overweight. Follow-up data showed that students reporting > or = 4 sessions per week (ie, high frequency) of low-intensity PA were twice as likely to have healthy BMIs as students engaging in low- and moderate-frequency PA. CONCLUSIONS: PA interventions should target freshmen with BMIs > or = 25.     

Think they're drunk? Alcohol servers and the identification of intoxication

Despite alcohol server training programs and legal liability aimed at controlling intoxication, server intervention appears to be rare. Given the difficulty in assessing intoxication, it can be assumed that improvement in assessment skills would increase the likelihood of intervention. Unfortunately, little is known regarding practices servers use to identify intoxication. In order to build a more informed base for policy formation and server training, the focus of this inquiry was to examine practices used by servers to assess intoxication. The analysis was based upon questionnaires mailed to a random probability sample of licensed servers from one state (N = 822). Indicators found to be most important were examined in relation to a variety of occupational characteristics. Implications for training curricula, policy formation, and future research are discussed.     

Selected Health Behaviors That Influence College Freshman Weight Change

Objective and Participants: The authors investigated the effect of physical activity (PA), fruit and vegetable intake, and alcohol use on 6-month weight change in 193 college freshmen (78.8% white, 88.2% women, 94.5% on a meal plan). Methods: The authors administered a Web-based survey in fall 2002 (baseline) and spring 2003 (follow-up). Results: There was an overall average weight gain of 2.5 lbs (p < .05), although only 57% reported weight gain (M = 7.1 lbs). Fruit and vegetable intake decreased (p = .034), alcohol use increased (p > .05), and PA was unchanged. Weight gain for students with body mass indexes (BMI) ≥25 kg/m² was nearly twice that of students with BMIs < 25 (p < .05). Students with low-frequency baseline PA were twice as likely to be overweight. Follow-up data showed that students reporting ≥ 4 sessions per week (ie, high frequency) of low-intensity PA were twice as likely to have healthy BMIs as students engaging in low- and moderate-frequency PA. Conclusions: PA interventions should target freshmen with BMIs ≥ 25.     

Gin Lane Revisited: Intoxication and Society in the Gin Epidemic

The massive increase in gin consumption which occurred in eighteenth-century London produced a marked shift in the cultural understanding of alcohol consumption. Prior to the formalization of addiction as a medical concept, gin consumption produced both sustained legal intervention and a wealth of concerned social commentary. This suggests that the medical construction of addiction is pre-dated by a social and political problematization of intoxication, and in many ways emerges from that process. Using William Hogarth's 1751 prints Beer Street and Gin Lane as its focal point, this paper argues that intoxication raised specific political and metaphysical problems for an emergent modernity. On the one hand, Hogarth reflects a series of common anxieties over urbanization, consumption, mass production and economic prosperity. On the other hand, he articulates a relationship between art, intoxication, and social class that prefigures modernist aesthetics and practice in the late nineteenth and early twentieth centuries. This paper explores both the ways in which intoxication was problematized in the gin epidemic and how that process inflected contemporary and subsequent representations of modern life in the arts.     

Pilot Study on Childhood Sexual Abuse,Diurnal Cortisol Secretion,and Weight Loss in Bariatric Surgery Patients

Childhood sexual abuse increases risk for adult obesity. A potential contributing factor is altered cortisol secretion. In this pilot study, relationships among childhood sexual abuse, diurnal salivary cortisol secretion, and weight loss were explored in 17 bariatric surgery patients. Measurement points were before surgery (baseline) and 3 and 6 months after surgery. Childhood sexual abuse was measured by the Childhood Trauma Questionnaire. The results showed moderate but nonsignificant positive correlations between the childhood sexual abuse subscale score and baseline morning cortisol, evening cortisol, and daily mean cortisol. An unexpected positive correlation was noted between the Childhood Trauma Questionnaire total score and weight loss at six months. Diurnal cortisol secretion did not change over time after surgery nor correlate significantly with weight loss at six months.     

Gender-related differences in physical performance among seniors

This study examined gender differences in balance, gait, and muscle performance in seniors and identified gender-specific factors contributing to physical performance. Forty (20 men, 20 women) healthy, community-dwelling seniors (74.5 +/- 5.3 years) participated. Limits of stability, gait speed, lower limb flexor and extensor isokinetic concentric peak torques, self-reported activity level, and balance confidence were measured. No gender differences were detected in gait speed, limits of stability when normalized to height, activity level, or balance confidence (p = .188). Women were weaker than men (p = .007), even after controlling for weight and body-mass index, suggesting that other gender-related factors contribute to strength. Gender accounted for 18-46% of the variance in strength and served as a modifier of the relationship between activity level and strength in some muscle groups. The primary factors relating to gender-specific strength was activity level in men and body weight in women.     

Community exercise program for older adults recovering from hip fracture: a pilot study

Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 +/- 6.0 years; 24 women; 71 +/- 23 days post-hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity-strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post-hip fracture.     

Predictors of exercise relapse in a college population

Exercise improves physical and mental health. Nevertheless, most 20-year-olds do not exercise, and approximately 50% of the participants in exercise programs drop out in the first 3 to 6 months. In view of the health benefits of exercise, college health educators and clinicians need to be able to identify factors that predict exercise relapse in a student population. The authors administered questionnaires measuring Prochaska's 10 processes of change for exercise, self-efficacy, and decisional balance to 52 physically active undergraduate students. They assessed baseline exercise levels in October and reassessed them about 8 weeks later. At baseline, relapsers had significantly lower self-efficacy scores than those who maintained their exercise levels. The relapsers also had higher perceived negative views of exercise. These findings provide support for applying the transtheoretical model of behavioral change to a college population.     

Analysing the effect of public health campaigns on reducing excess weight: a modelling approach for the Spanish Autonomous Region of the Community of Valencia

Excess weight is fast becoming a serious health concern in the developed and developing world. The concern of the public health sector has lead to the development of public health campaigns, focusing on two-fold goals: to inform the public as to the health risks inherent in being overweight, and the benefits of a change in nutritional behaviour. Recent studies indicate that the effects of the average public health campaign on the target community is around 5%. In this study we aim to quantify the effect of different public health campaigns on lifestyle behaviour in the target populations in order to bring about weightloss in a significant number of people over the next few years.This study is based on recent works that consider excess weight as a consequence of the transmission of unhealthy lifestyles from one individual to another. Following this point of view, first a mathematical model is presented. Then, policies based on public health campaigns addressed to stop people gaining weight (prevention; this type of policy acts on individuals in order to maintain their weight and to stop an increase in weight) and, policies addressed to overweight individuals to reduce their weight (treatment; these campaigns act on overweight and/or obese individuals in order to reduce their weight) are simulated in order to evaluate their effectiveness. The study concludes that combination of preventive plus treatment campaigns are more effective than considering them separately.     

Old and New Environmental Issues for College and University Health Services

Abstract

Exercise improves physical and mental health. Nevertheless, most 20-year-olds do not exercise, and approximately 50% of the participants in exercise programs drop out in the first 3 to 6 months. In view of the health benefits of exercise, college health educators and clinicians need to be able to identify factors that predict exercise relapse in a student population. The authors administered questionnaires measuring Prochaska's 10 processes of change for exercise, self-efficacy, and decisional balance to 52 physically active undergraduate students. They assessed baseline exercise levels in October and reassessed them about 8 weeks later. At baseline, relapsers had significantly lower self-efficacy scores than those who maintained their exercise levels. The relapsers also had higher perceived negative views of exercise. These findings provide support for applying the transtheoretical model of behavioral change to a college population.     

Union transitions and changes in BMI among adults in Mexico

This study utilizes nationally representative, longitudinal data from the Mexico Family Life Survey to examine the associations between union transitions and changes in body mass index (BMI) among adults in Mexico. Results from change score regression models (N = 11,339) indicate larger BMI gains for those entering a union than for those remaining single, net of baseline weight status and socioeconomic controls. Further, a significant moderating effect of baseline weight status suggests that overweight individuals entering a union gain almost two BMI points more than overweight single individuals during this three-year period. Individuals experiencing a union dissolution gain less BMI than those entering a union, but are predicted to lose BMI (as found in the United States) only if they are overweight before the transition.     

Explaining antigay violence using target congruence: an application of revised routine activities theory

This research examines predictors of antigay violence (physical assault, sexual assault, and property damage) using Finkelhor and Asdigian's (1996) revised routine activities theory, which predicts that target congruence increases victimization risk. Results indicate about half of the sample experienced at least one type of victimization, while 25% experienced two or more types. Physical violence was the most common type of antigay victimization, with property damage and sexual assault occurring less often. Having a higher level of contact with gay/lesbian organizations and being out of the closet or open about sexual orientation increases the risk of both physical assault and property damage. More frequent drinking to intoxication also increases the risk of antigay-motivated physical assault. The sexual assault model was not significant. Implications for future research and prevention are discussed.     

Exercise intervention designed to improve strength and dynamic balance among community-dwelling older adults

Loss of balance and falling are critical concerns for older adults. Physical activity can improve balance and decrease the risk of falling. The purpose of this study was to evaluate a simple, low-cost exercise program for community-dwelling older adults. Sixteen senior adults were evaluated using the Senior Fitness Test for measures of functional strength, aerobic endurance, dynamic balance and agility, and flexibility. In addition, measures of height, weight, resting blood pressure, blood lipids, and cognitive function were obtained. Participants then attended a 10-week exercise class including stretching, strengthening, and balance-training exercises. At the completion of the program, significant improvements were observed in tests measuring dynamic balance and agility, lower and upper extremity strength, and upper extremity flexibility. The results indicate that exercise programs such as this are an effective, low-cost solution to improving health and factors that affect falling risk among older adults.     

Frenzied attacks. A micro‐sociological analysis of the emotional dynamics of extreme youth violence

Inspired by phenomenological and interactionist studies of youth violence, this article offers an empirical evaluation of Collins's micro‐sociological theory of violence. The main question is whether situations of extreme violence have distinct situational dynamics. Based on analyses of 159 interactions taken from judicial case files, situations of extreme youth violence, here called frenzied attacks, were identified on the basis of the state of encapsulation of the attackers (absorbed in the violence, their sole focus is the destruction of the victim) and the disproportionateness of the violence (the attackers continue to hurt the victims even though they do not pose a threat or a challenge to them). Qualitative and statistical analyses revealed that this emotional state results from a social figuration in which the emotional balance shifts toward complete dominance of the attackers. Thus, the occurrence of frenzied attacks is associated with the moment victims hit the ground, paralyse and start to apologize, with the numerical dominance of the attackers' supportive group and with feelings of group membership, in the form of solidarity excitement and family ties in the attackers' group. Alcohol intoxication is of influence as well, but contrary to the expectation, this effect was independent from solidarity excitement. The article concludes that Collins's theory on the emotional dynamics of violence adds a new dimension to the phenomenological and interactionist traditions of research.