SON Rises to 4th in NIH Funding Rankings

This year, the SON reclaimed its spot in the top five nursing schools that receive funding from the National Institutes of Health (NIH). For 2008, the NIH awarded the School 13 grants, totaling $6.42 million, putting the SON in fourth place. This was an increase from the sixth place ranking from 2007 that included 12 grants and $5.97 million of funding.

SON Researcher Discovers Pregnant Women More Likely To Stretch Than Walk

Pregnant women who exercise by stretching are more likely to maintain their exercise activities until the end of pregnancy compared to women who walk for exercise, according to a SON study published in August issue of Research in Nursing & Health.

In a study of 124 women, most of whom were white, well educated and relatively affluent, SON associate professor SeonAe Yeo, PhD, RNC, FAAN, found that women who follow a regimen of stretching continue to exercise longer into their pregnancies.

Study participants were asked to adhere as closely as possible to 40-minute-a-day, five-times-a-week exercise schedule. The walking exercise involved moderate-intensity walking, i.e. walking to 55 percent to 69 percent of age-determined maximum heart rate. The stretching exercise included an instructional videotape of slow muscle movements with no aerobic or muscle resistance components.

These findings are secondary conclusions from a previous study focused on determining whether stretching is more effective than walking at reducing a woman’s risk of preeclampsia during pregnancy.

“Based on our results, we found that women who stretch for exercise during pregnancy have more favorable blood pressure changes throughout gestation, were more likely to stay within the recommended weight-gain limits, and they experienced less fluctuation in their resting heart rate during late pregnancy,” Yeo said. “With our original study looking at exercise’s effect on the risk of preeclampsia, these findings highlight the fact that the type of exercise also influences a woman’s likelihood of sticking with it to realize a protective benefit.”

The rate of adherence to the exercise routine was measured at 18 weeks, 28 weeks and 38 weeks. At each evaluation point, stretchers reported exercising more times per week than walkers. The length of time walkers spent exercising also declined from one evaluation to the next (36 minutes to 33 minutes to 31 minutes).

To read the entire study: http://www3.interscience.wiley.com/journal/117871052/issue

Observational Laboratory Aids Nurse Scientists in Childhood Obesity Study

Eric Hodges, PhD, RN, sits in front of two monitors  watching a mother feed her infant child, joystick in hand.  Dr. Hodges is a new breed of nurse researcher-scientist who is using high tech data collection to study the cues that mothers and children give each other during the feeding process.  As he watches the interactions — innate reflexes, facial and body responses — he moves the joystick to zoom in on his research subjects.  He watches for muscle tension and relaxation, eye contact intensity, and general engagement between the dyad.

At a computer across the room, a master’s prepared student worker is coding videotapes of mothers and their children and their responses to each other during feeding.  Is the mom watching TV?  Does the child turn his head away from the bottle perhaps signaling sufficient food intake?  Is baby fussy or content or active or passive?  What does this all mean if feeding is a central interaction in the relationship between mother and child?  How might a father who misses his child’s feeding cues contribute to food that child’s intake in later life?

These are some of the questions asked in the NIH funded longitudinal study that Dr. Hodges is conducting in the observational laboratory in the UNC Chapel Hill School of Nursing Biobehavioral Laboratory.  The laboratory, the only one of its kind at the University, is equipped with six cameras and sophisticated audio equipment to give researchers multiple views of subject interactions and to hear the verbal cues that mothers and infants give each other, too.  Cooing, crying, singing, humming, whispering and talking are all recorded and then later analyzed according to a scheme developed by researchers at Baylor School of Medicine where Hodges completed his post-doctoral education before being recruited to UNC Chapel Hill.

The literature says that infants have the capacity to self-regulate and their food intake needs can vary from feeding to feeding.  Parents who allow the child to push away when they are full or who understand and are attuned to those cues that infants and children give — and Hodges has identified these cues for fullness — may be supporting healthier behaviors for life.

One goal of the study is to provide education for prospective parents about ways to support a healthy feeding environment.  Another is to track youngsters based on the types of cues they received from parents to see if outcomes overtime contributed to obesity and Type II Diabetes onset in children.

Hodges was a Nurse Practitioner before he decided to go back to school to complete a PhD and become a nurse scientist.  Hodges notes  that the research he and other nurse scientists conduct helps support  RNs at the bedside who use the evidence-based knowledge he develops to improve the quality of care for patients and their families.

Health Care in the Genomic Era: A More Personalized Approach to Health Care

Friday, April 3, 2009, Carrington Hall Room 9

The University of North Carolina at Chapel Hill School of Nursing

1:00-1:15: Welcome/Introductions

Marcia Van Riper, PhD, RN

Chair, Family Health Division School of Nursing

Carolina Center for Genome Sciences, UNC-CH

1:15-1:45: Poster Session and Refreshments (light lunch)

UNC SON Students will be presenting Genetics and Family Posters they have developed for N382 (Family Centered Genomic Health Care). The posters will be on display on the ground floor of Carrington Hall and in the lobby of the new addition.

1:45-2:15: Personalized HealthCare: The Coming Storm

James P. Evans MD, Ph.D,

Bryson Professor of Genetics and Medicine, UNC-CH

2:15-2:45: Pharmacogenomics: This is the Drug for You!

Howard L. McLeod, Pharm D

Fred N. Eshelman Distinguished Professor- Director, UNC Institute for Pharmacogenomics and Individualized Therapy, UNC-CH

2:45-3:15: Break with Refreshments

3:15-3:30: Clinician Knowledge and Attitudes about Pharmacogenetic Testing: Preliminary Findings

Marcia Van Riper, PhD, RN

3:30-4:00 Panel: Integration of Recent Advances in Genomics into the Clinical Setting

Wylie Burke, PhD, MD, University of Washington

UNC SON Student – Mary Kakefuda

Jim Evans and Howard McLeod

This program was made possible, in part, through the

Barbara A. Senich Genomics Innovation Fund in the School of Nursing

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SON Study Shows Stretching May Reduce Preeclampsia Risk For Some

Stretching exercises may be effective at reducing the risk of preeclampsia for pregnant women who have already experienced the condition and who do not follow a workout routine, according to researchers at the University of North Carolina at Chapel Hill School of Nursing.

Preeclampsia, or pregnancy-induced hypertension, is a condition that affects up to 8 percent of pregnancies every year and is among the leading causes of maternal and fetal illness and death worldwide.

The finding is contrary to existing studies and literature that suggest that rigorous exercise is the most effective way to reduce the risk of preeclampsia, said SeonAe Yeo, Ph.D., an associate professor with a specialty in women’s health at the UNC School of Nursing and the study’s lead researcher.

Yeo will present the findings Thursday (May 29) at the annual meeting of the American College of Sports Medicine in Indianapolis, Ind. The results will be published in the spring issue of the journal Hypertension in Pregnancy.

Preeclampsia is characterized by a marked increase in blood pressure during pregnancy and may be accompanied by swelling and kidney problems. It is diagnosed when blood pressure readings taken twice in six hours read 140/90 or higher.

“These results seemingly contradict the conventional wisdom that walking is the best protection pregnant women have against developing preeclampsia,” Yeo said. “But for women who were not physically active before becoming pregnant and who have experienced preeclampsia with a previous pregnancy, that might not be the case.”

From November 2001 to July 2006, 79 women with a previous preeclampsia diagnosis and a sedentary lifestyle participated in this National Institute of Nursing Research-funded study. Women were randomly assigned to either the walking group (41 women) or the stretching group (38 women) during the 18th week of pregnancy.

The walking group was asked to exercise for 40 minutes five times a week at moderate intensity, following the program recommended by the Surgeon General and the American College of Obstetrics and Gynecology. Stretchers were also asked to perform slow, non-aerobic muscle movements with a 40-minute video fives times a week. Frequency and duration of exercise decreased in both groups as the pregnancy progressed.

At the end of pregnancy, almost 15 percent of women in the walking group had developed preeclampsia. Less than 5 percent of the stretching group developed the condition. While the incidence of preeclampsia in the walking group was similar to that reported in high-risk pregnancies, the frequency among the stretching group was similar to rates seen among the general population.

“Clearly, walking does not have a harmful effect during pregnancy,” Yeo said. “But for women who are at high risk for preeclampsia, our results may suggest that stretching exercises may have a protective effect against the condition.”

Stretching could provide protection against preeclampsia because stretchers produced more transferrin than walkers did, Yeo said. Transferrin is a plasma protein that transports iron through the blood and protects against oxidative stress on the body.

Yeo said these results could help prenatal care providers recommend different exercise plans based on an individual pregnant woman’s needs and abilities. Following an active exercise plan is good, she said, but only if a pregnant woman is truly able to do it. For some who already have a risk of preeclampsia, stretching might be a better option.

Co-authors of the study include Sandra Davidge, Ph.D., the University of Alberta; David L. Ronis, Ph.D., the University of Michigan School of Nursing and Veteran Administration Hospital; Cathy L. Antonakos, Ph.D., the University of Michigan School of Nursing; Robert Hayashi, M.D., the University of Michigan; and Sharon O’Leary, M.D., St. Joseph Mercy Health Systems.

School Holds Celebration of Nursing Research Event

On April 14, the School held its first Celebration of Nursing Research, showcasing more than 30 research studies and recognizing 14 students who will graduate with honors in May. The Undergraduate Program office, Research Enrichment and Apprenticeship Program (REAP) and the Alpha Alpha Chapter of Sigma Theta Tau co-sponsored the event.

Students presented their research either from the podium or as a poster. Posters were displayed in the lobby of Fox Auditorium. Topics ranged from improving gender diversity in the nursing profession to studying nurses’ experiences in providing end-of-life care in an intensive care unit to the social competencies and behavioral problems among youths reared by grandmothers.

Faculty, staff, students’ families and donors to the School attended the reception and discussed research findings with the students.

9,120 Pieces of Trident Chewing Gum Gifted for Breast Cancer Research Study

Cadbury Adams, the manufacturers of Trident Gum, made a gift of 31 boxes of Trident Original flavor — that’s 9,120 pieces of gum — to help nursing researchers at the University of North Carolina at Chapel Hill School of Nursing understand more about managing uncertainty in younger breast cancer survivors. “The chewing gum is necessary for the cortisol collection part of the study,” said Merle Mishel, PhD, RN, FAAN, the principal investigator for the National Institute of Nursing Research study. “Chewing gum helps subjects produce saliva for the samples.”

Why are samples of cortisol needed? Individuals under chronic stress have been shown to have decreased cortisol reactivity which is related to adverse health outcomes. The Carolina SON research team is studying how the fear of recurrence for younger breast cancer survivors results in a pervasive sense of a less controllable world, thereby, potentially increasing their uncertainty about cancer recurrence, which may constitute a form of chronic stress.  Chronic stress is known to weaken the immune system.

About 178,500 women in the United States were diagnosed with breast cancer in 2007; of this group, approximately 25 percent will be under 50 years of age. In the first four years following treatment, pre-menopausal women under 50 have a high recurrence rate and an increased likelihood of a second primary tumor. Uncertainty about how to interpret and handle symptoms leads to excessive worry, avoidance of symptoms or somatic vigilance. There has been little research on young survivors during the period of extended survival. Therefore, it is important to test interventions to help these women control their symptoms and manage the uncertainty about recurrence, and improve their quality of life.

There is some evidence that the impact of a breast cancer diagnosis is greater on African-American survivors and they experience more energy loss, sensory and sleep problems, pain and mental distress. African-American breast cancer survivors have rarely been included in intervention studies. This study, however, includes a significant sample of this group.

The Managing Uncertainty in Cancer Patients (MUIC) team has designed and tested a succesful intervention for older breast cancer survivors (mean 64 years of age) who were 5-9 years post treatment. This is currently being distributed by the National Cancer Institute as a model intervention program. The link is: http://rtips.cancer.gov/rtips/rtips_details.do?programid=82&topicid=12&co=n&cg=

The link will go to “RTIPs Program Use Agreement.” Please click accept button below to continue. Click on the “Product” image to download documents or to order a CD.

Most pre-menopausal women also experience an intense reponse to treatment induced premature menopause, including debilitating hot flashes, mood and sleep impairment, memory impairment, sexual dysfunction, and fatigue, yet little information from physicians is offered to help them with these treatment issues. The nursing intervention developed by MUIC places a greater focus on calming self-statements and cognitive restructuring to enhance the benefits of the intervention, which can be practiced by women on their own at home, with a self-help guide manual that can be used on as as-needed basis.

A Need for Chewing Gum and Breast Cancer Research: Why?

Managing Uncertainty in Cancer Patients (MUIC)and Breast Cancer: A Successful Nursing Intervention A Need for Chewing Gum to Further the Research Study. About 178,500 women in the United States were diagnosed with breast cancer in 2007; of this group, approximately 25 percent will be under 50 years of age. In the first four years following treatment, pre-menopausal women under 50 have a high recurrence rate and an increased likelihood of a second primary tumor. The fear of recurrence for younger breast cancer survivors results in a pervasive sense of a less controllable world. Indeed, the frequent and unpredictable intrusion of thoughts of uncertainty about cancer recurrence may constitute a form of chronic stress. Individuals under chronic stress have been shown to have decreased cortisol reactivity which is related to adverse health outcomes. Most pre-menopausal women also experience an intense response to treatment-induced premature menopause, including debilitating hot flashes, mood and sleep impairment, memory impairment, sexual dysfunction, and fatigue, yet little information from physicians is offered to help them with these treatment issues. Uncertainty about how to interpret and handle symptoms leads to excessive worry, avoidance of symptoms or somatic vigilance. There has been little research on young survivors during the period of extended survival. Therefore, it is important to test interventions to help these women control their symptoms and manage the uncertainty about recurrence, and improve their quality of life. There is some evidence that the impact of a breast cancer diagnosis is greater on African-American survivors and they experience more energy loss, sensory and sleep problems, pain and mental distress. African-American breast cancer survivors have rarely been included in intervention studies.

MUIC Intervention. MUIC has designed and tested a successful intervention (UMI) for older breast cancer survivors (mean 64 years of age) who were 5-9 years post treatment. The UMI consisted of audiotapes of cognitive coping skills to manage the triggers of intrusive thoughts about the uncertainty of recurrence, along with a manual containing strategies for managing long-term treatment side effects found among survivors. This is currently being distributed by the National Cancer Institute as a model intervention program.http://rtips.cancer.gov/rtips/rtips_details.do?programid=82&topicid=12&co=n&cg=
The link will go to “RTIPs Program Use Agreement” Please click accept button below to continue. Click on the “Product” image to download documents or to order a CD.

Given the prevalence of intrusive thoughts about recurrence with these women, we will place a greater focus on calming self-statements and cognitive restructuring to enhance the benefits of the intervention for this group. We will also include a new component on skills in communication with the health care provider. The cognitive behavioral strategies will again be primarily taught through a series of audiotapes that will be practiced by women on their own at home, and the revised manual will continue to be a self-help guide that women use on an as-needed basis.

Need: Chewing Gum for Study Subjects. The chewing gum is necessary for the cortisol collection part of the study. Cortisol in saliva is used as an indicator of stress levels. Chewing gum helps subjects produce saliva for the samples. Subjects are given one piece of gum for each saliva set required with two additional pieces for practice. Each subject sample requires 38 pieces of gum. MUIC needs to run 240 subjects, requiring about 9,120 pieces of gum. We are seeking a charitable gift from a donor to provide a tax-deductible contribution of $500 to enable the School of Nursing to purchase the gum for the study. MUIC is currently using Trident Original flavor. Any gum other than Trident Brand Original Flavor must be pre-approved by Brant Nix at the University of North Carolina at Chapel Hill School of Nursing Biobehavioral Laboratory to determine if additives or food coloring will affect the lab work.

Contact: Norma Hawthorne, Director of Advancement, UNC Chapel Hill School of Nursing, CB 7460Chapel Hill, NC 27599-7460. Norma_Hawthorne@unc.edu or call (919) 966-4619.

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