Publications by authors named "Kathryn A Lee"

162 Publications

Predictors of chronic pain and level of physical function in total knee arthroplasty: a protocol for a systematic review and meta-analysis.

BMJ Open 2020 09 10;10(9):e037674. Epub 2020 Sep 10.

Department of Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway.

Introduction: One in five patients undergoing total knee arthroplasty (TKA) experience unchanged or worse pain and physical function 1 year after surgery. Identifying risk factors for unfavourable outcomes is necessary to develop tailored interventions to minimise risk. There is a need to review more current literature with updated methodology that addresses the limitations of earlier systematic reviews and meta-analyses. We present a Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols compliant protocol for a systematic review and meta-analysis of predictors of chronic pain and impaired function after TKA.

Methods And Analysis: This review will include prospective longitudinal observational studies, or randomised trials (including cluster and crossover designs) that report arm-wise predictors of chronic postsurgical pain or impaired physical function at 3 months, 6 months or 12 months. A comprehensive literature search of studies published between 2000 and 2019 will be performed in Medline, Embase, CINAHL, Cochrane Library and PEDro. Blinded assessment with consensus agreement will be applied for inclusion of studies, data extraction and assessment of bias risk (Quality in Prognosis Studies tool). The co-primary outcomes, pain and impaired function, at 12 months after TKA will be analysed separately. Estimates of association between each outcome and any preoperative or intraoperative factor that may predict chronic pain or impaired physical function will be extracted from the included studies, where possible. For randomised studies, results will only be extracted from TKA arms (or the first period of crossover trials). Estimates of association from the primary evidence will be synthesised narratively, and quantitatively using multivariate meta-analysis to provide 'pooled' estimates of association. Subgroup and sensitivity analyses will be performed. Certainty of evidence for each predictor will be derived from the Grading of Recommendations Assessment, Development and Evaluation framework.

Ethics And Dissemination: No ethical issues are associated with this project. The results from this review will be published in peer-reviewed journals and presented at international conferences.

Prospero Registration Number: CRD42018079069.
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http://dx.doi.org/10.1136/bmjopen-2020-037674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7485240PMC
September 2020

Psychometric properties of a short version of Lee Fatigue Scale used as a generic PROM in persons with stroke or osteoarthritis: assessment using a Rasch analysis approach.

Health Qual Life Outcomes 2020 Jun 5;18(1):168. Epub 2020 Jun 5.

Faculty of Health and Society, Malmö University, 205 06, Malmö, Sweden.

Background: Fatigue is a common symptom associated with a wide range of diseases and needs to be more thoroughly studied. To minimise patient burden and to enhance response rates in research studies, patient-reported outcome measures (PROM) need to be as short as possible, without sacrificing reliability and validity. It is also important to have a generic measure that can be used for comparisons across different patient populations. Thus, the aim of this secondary analysis was to evaluate the psychometric properties of the Norwegian 5-item version of the Lee Fatigue Scale (LFS) in two distinct patient populations.

Methods: The sample was obtained from two different Norwegian studies and included patients 4-6 weeks after stroke (n = 322) and patients with osteoarthritis on a waiting list for total knee arthroplasty (n = 203). Fatigue severity was rated by five items from the Norwegian version of the LFS, rating each item on a numeric rating scale from 1 to 10. Rasch analysis was used to evaluate the psychometric properties of the 5-item scale across the two patient samples.

Results: Three of the five LFS items ("tired", "fatigued" and "worn out") showed acceptable internal scale validity as they met the set criterion for goodness-of-fit after removal of two items with unacceptable goodness-of-fit to the Rasch model. The 3-item LFS explained 81.6% of the variance, demonstrated acceptable unidimensionality, could separate the fatigue responses into three distinct severity groups and had no differential functioning with regard to disease group. The 3-item version of the LFS had a higher separation index and better internal consistency reliability than the 5-item version.

Conclusions: A 3-item version of the LFS demonstrated acceptable psychometric properties in two distinct samples of patients, suggesting it may be useful as a brief generic measure of fatigue severity.

Trial Registration: Clinicaltrials.gov: NCT02338869; registered 10/04/2014 (stroke study).
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http://dx.doi.org/10.1186/s12955-020-01419-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275526PMC
June 2020

Is adequate sleep enough, or is it time to add lipid-lowering medication to prenatal vitamin recommendations to improve infant outcomes?

Sleep Med 2021 Jan 17;77:374-375. Epub 2020 Jan 17.

Department of Family Health Care Nursing, School of Nursing, Box 0606, University of California, San Francisco, San Francisco, CA, 94143, USA. Electronic address:

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http://dx.doi.org/10.1016/j.sleep.2020.01.006DOI Listing
January 2021

Beyond the bladder: poor sleep in women with overactive bladder syndrome.

Am J Obstet Gynecol 2020 06 10;222(6):600.e1-600.e13. Epub 2019 Dec 10.

Department of Medicine, University of California San Francisco, CA.

Background: Nocturnal bladder symptoms and sleep disruption commonly coexist in middle-aged and older women. Although sleep disruption is often attributed to nocturnal bladder symptoms in women with overactive bladder syndrome, nonbladder factors also may influence sleep in this population. Many women with overactive bladder are eager to identify nonpharmacologic strategies for both bladder symptoms and sleep disruption, given the potential adverse effects of sedative and anticholinergic bladder medications in this population.

Objectives: To provide greater insight into the complex relationship between nighttime overactive bladder symptoms and sleep disruption, and to evaluate the effects of a guided slow-paced respiration intervention on sleep outcomes in women with overactive bladder.

Study Design: We conducted an ancillary study within a randomized trial of slow-paced respiration in women with overactive bladder symptoms. Ambulatory community-dwelling women who reported ≥3 episodes/day of urgency-associated voiding or incontinence were randomized to use either a portable biofeedback device (RESPeRATE; Intercure, Ltd) to practice guided slow-paced respiration exercises daily for 12 weeks (N=79) or an identical-appearing device programmed to play nonrhythmic music without guiding breathing (N=82). At baseline and after 12 weeks, bladder symptoms were assessed by voiding diary, sleep duration, and disruption were assessed by sleep diary corroborated by wrist actigraphy, and poor sleep quality was determined by a Pittsburgh Sleep Quality Index global score >5.

Results: Of the 161 women randomized, 31% reported at least twice-nightly nocturia, 26% nocturnal incontinence, and 70% poor sleep quality at baseline. Of the 123 reporting any nighttime awakenings, 89% averaged 1 or more nighttime awakenings, and 83% attributed at least half of awakenings to using the bathroom. Self-reported wake time after sleep onset increased with increasing frequency of nocturnal bladder symptoms (P=.01 for linear trend). However, even among women without nocturia, average sleep quality was poor (Pittsburg Sleep Quality Index global score mean of 7.3; 95% confidence interval, 6.0-8.6). Over 12 weeks, women assigned to slow-paced respiration (N=79) experienced modest improvements in mean nocturnal voiding frequency (0.4 fewer voids/night), sleep quality (1.1 point score decrease), and sleep disruption (1.5% decreased wake time after sleep onset). However, similar improvements were detected in the music control group (N=81), without significant between-group differences.

Conclusions: Many women with overactive bladder syndrome experience disrupted sleep, but not all nocturnal awakenings are attributable to bladder symptoms, and average sleep quality tends to be poor even in women without nocturia. Findings suggest that clinicians should not assume that poor sleep in women with overactive bladder syndrome is primarily caused by nocturnal bladder symptoms. Guided slow-paced respiration was associated with modest improvements in nocturia frequency and sleep quality in this trial, but the results do not support clinician recommendation to use this technique over other behavioral relaxation techniques for improving sleep.
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http://dx.doi.org/10.1016/j.ajog.2019.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263944PMC
June 2020

Depressive symptoms associated with physical health problems in midlife women: A longitudinal study.

J Affect Disord 2020 02 2;263:301-309. Epub 2019 Dec 2.

School of Nursing, University of California, Box 0606, Room N411Y, San Francisco, CA 94143-0606, United States. Electronic address:

Background: It is unclear if the relationship between depression and physical health problems in women is related to age, reproductive stage, obesity or socio-demographic risk factors.

Methods: Longitudinal data were obtained every 6 months for 36 months in 264 midlife African American, Caucasian and Latina women who began the study as healthy regularly menstruating 40 to 50-year-olds; 75 transitioned to peri- or post-menopause by 36 months. Scores of 16 or higher on the Center for Epidemiologic Studies-Depression (CES-D) scale were used to estimate depression risk.

Results: Depression risk was 28% at study initiation and 25% at 36 months. Significantly more women at risk for depression were unemployed, obese, or hypertensive. Women at risk were more likely to become peri- or post-menopausal during the study period. A higher percentage (38%) of overweight and obese women had CES-D scores ≥ 16 compared to normal weight women (23%; p < .001). Over half (58%) of the 73 women at higher depression risk at the initial visit reported a health problem or chronic illness at 36 months, compared to only 36% of the 191 women with CES-D scores <16 (p = .001).

Limitations: This was a secondary analysis of data from a relatively healthy sample of women in the decade before menopause. Chronic illness was self-reported and the CES-D is a screening tool for depressive symptoms rather than a clinical diagnostic tool.

Conclusions: Health care providers may be underestimating the impact of unemployment on depressive symptoms, obesity and chronic health problems in midlife women.
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http://dx.doi.org/10.1016/j.jad.2019.11.166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989369PMC
February 2020

Daytime and nighttime correlates of fatigue and lack of energy in adults living with HIV.

Chronic Illn 2019 Nov 10:1742395319884110. Epub 2019 Nov 10.

Department of Family Health Care Nursing, University of California, San Francisco, CA, USA.

Objective: To describe correlates of fatigue and lack of energy symptoms in adults living with HIV.

Methods: Adults living with HIV were recruited if they were ≥45 years old, unemployed, and reported either fatigue or lack of energy in the past week. HIV-associated correlates included CD4 cell count, viral load, and hemoglobin. Daytime correlates included physical activity, daytime sleepiness, napping behavior, and symptoms of anxiety and depression. Nighttime correlates included use of sleep medication, sleep duration, and sleep quality. Outcomes included physical and cognitive function.

Results: Most (70%) of the 53 participants were male. The mean age was 56.7 ± 6.7 years and participants had been living with HIV for a mean of 22 ± 6.4 years. Controlling for all other factors, African Americans reported less fatigue and more energy than other racial/ethnic groups. Lack of energy was associated with daytime napping and cognitive function. Fatigue was associated with shorter nighttime sleep duration, anxiety, and both physical and cognitive function.

Discussion: Findings highlight potential differences between lack of energy and fatigue that could influence intervention outcomes. Avoiding daytime naps and encouraging longer nighttime sleep may improve fatigue as well as physical and cognitive function in this chronic illness population.
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http://dx.doi.org/10.1177/1742395319884110DOI Listing
November 2019

Obstructive sleep apnea risk and subclinical atherosclerosis in South Asians living in the United States.

Sleep Health 2020 02 4;6(1):124-130. Epub 2019 Nov 4.

Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611.

Objectives: The objective of this study was to examine the association between high risk of obstructive sleep apnea (OSA) and subclinical atherosclerosis among South Asians in the United States.

Design: A secondary analysis of cross-sectional data.

Setting/participants: A community-based cohort of 906 men and women participating in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.

Measurements: The Berlin Questionnaire was used to screen for OSA risk. Coronary artery calcium (CAC), common carotid artery intima-media thickness (IMT), and internal carotid artery IMT were used as measures of subclinical atherosclerosis.

Results: The majority of participants (59%) with high OSA risk had CAC scores >0 compared with only 41% of participants with low OSA risk (P <.001). The high OSA risk group was older (P =.005), male (P =.04), had higher body mass index (P <.001) and had greater common carotid artery IMT (0.96 ± 0.27 mm) and internal carotid artery IMT (1.33 ± 0.42 mm) measurements. Snoring, sleep-disordered breathing (SDB), and high OSA risk were associated with subclinical atherosclerosis. However, only high OSA risk remained significant in multivariable models after controlling for demographic and clinical factors that included hypertension (HTN), obesity, diabetes, and dyslipidemia.

Conclusions: High OSA risk, which includes overlapping comorbidities of HTN and obesity, was not associated with the time living in the US but was associated with subclinical atherosclerosis markers. These cardiovascular disease risk factors should include evaluation of the spectrum of SDB among all adults, including South Asian men and women.
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http://dx.doi.org/10.1016/j.sleh.2019.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995439PMC
February 2020

Fatigue management for adults living with HIV: A randomized controlled pilot study.

Res Nurs Health 2020 01 14;43(1):56-67. Epub 2019 Oct 14.

Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California.

Fatigue is a prevalent symptom for adults living with HIV infection. The purpose of this randomized clinical trial was to pilot test a behavioral-educational intervention to reduce fatigue. The intervention included education about daytime behaviors as well as nighttime sleep behaviors. Participants were HIV-positive, between 45 and 75 years old, unemployed, and experiencing fatigue. They were randomized to intervention (n = 25) or control (n = 26) after obtaining baseline measures, administered the intervention or attention control, and followed with monthly assessments for 3 months. Primary outcome measures included the Fatigue Severity Scale (FSS) and fatigue symptom burden using the four-dimension structure of the Memorial Symptom Assessment Scale that includes occurrence, frequency, severity, and distress of a symptom. Other measures included the International Physical Activity Questionnaire, step counts with a Fitbit Flex, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Sleep Behavior Rating Scale. Compared with attention controls, the intervention group had significantly (p < .05) lower FSS scores and fatigue symptom burden over time, particularly in the frequency dimension. Secondary outcomes for reducing daytime naps and improving sleep quality were also significant (p < .05). This intervention, focused on both daytime and nighttime behaviors, demonstrated promising effects for reducing fatigue among adults living with HIV. Results provide useful direction for larger clinical trials to reduce fatigue in adults living with other types of chronic illness.
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http://dx.doi.org/10.1002/nur.21987DOI Listing
January 2020

Sleep Disturbances in Midlife Women at the Cusp of the Menopausal Transition.

J Clin Sleep Med 2018 07 15;14(7):1127-1133. Epub 2018 Jul 15.

Department of Family Health Care Nursing, University of California, San Francisco, California.

Study Objectives: To compare causes of sleep disturbance and to compare self-reported sleep duration among groups of late premenopausal women and early perimenopausal women.

Methods: In a longitudinal study of a community-based sample of healthy women 40 to 50 years of age, menstrual cycle and symptom data were collected every 2 months; anthropometric measures, a urine sample for follicle stimulating hormone (FSH), and the Pittsburgh Sleep Quality Index (PSQI) measures were collected every 6 months.

Results: At 12 to 18 months, 206 women remained premenopausal and 69 women became perimenopausal. Poor sleep quality (PSQI score > 5) was experienced by 42% of the total cohort. Awakening to use the bathroom was the most frequent reason (81%) for sleep disturbance in the entire cohort, followed by feeling too hot (26%). However, premenopausal women were significantly more likely to awaken to use the bathroom than perimenopausal women ( = .047), and perimenopausal women were more likely than premenopausal women to awaken because of feeling too hot ( = .002). Women in early perimenopause reported shorter sleep duration ( = .007) and worse sleep quality ( = .05) than premenopausal women of similar age.

Conclusions: Sleep disturbance is a significant issue for midlife women regardless of age or reproductive stage. Identification of salient factors that disrupt sleep, such as nocturia prior to menopausal transition or feeling too hot early in menopausal transition, will provide direction for developing tailored intervention strategies to improve sleep and quality of life.

Commentary: A commentary on this article appears in this issue on page 1095.
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http://dx.doi.org/10.5664/jcsm.7208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040789PMC
July 2018

Short and Sweet: A commentary on short sleep duration and hyperglycemia in pregnancy.

Authors:
Kathryn A Lee

Sleep Med Rev 2018 08 21;40:28-30. Epub 2018 Feb 21.

School of Nursing, University of California, San Francisco, San Francisco CA 94143, United States. Electronic address:

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http://dx.doi.org/10.1016/j.smrv.2018.02.005DOI Listing
August 2018

Risk of Obstructive Sleep Apnoea is Associated with Glycaemia Status in South Asian Men and Women in the United States.

Obes Med 2018 Mar 1;9:1-6. Epub 2017 Dec 1.

Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA 94115.

Aims: To examine the association between glycaemia status and the risk for obstructive sleep apnoea (OSA) in a cohort of South Asians living in the United States.

Methods: A secondary analysis of a community based cohort of 899 participants from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. The Berlin Questionnaire was used to screen for OSA.

Results: Almost one in four (24%) South Asians was at high risk for OSA. Compared to the normal glucose tolerance group (18%), high risk of OSA was significantly more likely in the prediabetes (24%) and diabetes (32%) groups ( = .007). More men (28%) than women (18%) were at high risk of OSA. Risk for OSA was also associated with higher haemoglobin A1c values, hypertension, large waist circumference, and BMI > 27.5 kg/m. In a multivariate regression analysis, sleep disordered breathing (SDB) remained significantly associated with higher haemoglobin A1c values, even after controlling for waist circumference and other demographic and clinical factors.

Conclusions: The risk for SDB and OSA was high among South Asian men and women. Given the association between dysglycaemia and risk for OSA, these health issues require simultaneous clinical assessment. Future studies using objective sleep measures such as polysomnography are warranted in the diagnosis and treatment of OSA in the South Asian adult population already at high risk for dysglycaemia.
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http://dx.doi.org/10.1016/j.obmed.2017.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771438PMC
March 2018

Restriction of dietary protein leads to conditioned protein preference and elevated palatability of protein-containing food in rats.

Physiol Behav 2018 02 7;184:235-241. Epub 2017 Dec 7.

Department of Neuroscience Psychology & Behaviour, University of Leicester, University Road, Leicester LE1 9HN, United Kingdom. Electronic address:

The mechanisms by which intake of dietary protein is regulated are poorly understood despite their potential involvement in determining food choice and appetite. In particular, it is unclear whether protein deficiency results in a specific appetite for protein and whether influences on diet are immediate or develop over time. To determine the effects of protein restriction on consumption, preference, and palatability for protein we assessed patterns of intake for casein (protein) and maltodextrin (carbohydrate) solutions in adult rats. To induce a state of protein restriction, rats were maintained on a low protein diet (5% casein) and compared to control rats on non-restricted diet (20% casein). Under these dietary conditions, relative to control rats, protein-restricted rats exhibited hyperphagia without weight gain. After two weeks, on alternate conditioning days, rats were given access to either isocaloric casein or maltodextrin solutions that were saccharin-sweetened and distinctly flavored whilst consumption and licking patterns were recorded. This allowed rats to learn about the post-ingestive nutritional consequences of the two different solutions. Subsequently, during a preference test when rats had access to both solutions, we found that protein-restricted rats exhibited a preference for casein over carbohydrate whereas non-restricted rats did not. Analysis of lick microstructure revealed that this preference was associated with an increase in cluster size and number, reflective of an increase in palatability. In conclusion, protein-restriction induced a conditioned preference for protein, relative to carbohydrate, and this was associated with increased palatability.
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http://dx.doi.org/10.1016/j.physbeh.2017.12.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766754PMC
February 2018

Improving Sleep for Hospitalized Antepartum Patients: A Non-Randomized Controlled Pilot Study.

J Clin Sleep Med 2017 12 15;13(12):1445-1453. Epub 2017 Dec 15.

Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, California.

Study Objectives: To evaluate feasibility and efficacy of a hospital-based protocol for improving sleep in high- risk antepartum patients.

Methods: Sleep measures were compared during 1 week of hospitalization before and after implementing a Sleep Improvement Protocol for Antepartum Patients (SIP-AP). A non-randomized convenience sample of usual care controls was compared to a subsequent intervention sample after the protocol was implemented. Women were eligible if they spoke English, were medically stable, pregnant for at least 20 weeks, and hospitalized at least 24 hours; 25 pregnant women had sufficient data for analyses (11 controls, 14 intervention). Sleep was assessed in 3 ways: the Pittsburgh Sleep Quality Index was completed after obtaining consent to estimate sleep quality prior to hospital admission; sleep diary completed each hospital day; and General Sleep Disturbance Scale completed at 7 days or prior to hospital discharge. Symptoms that could affect sleep were assessed with the Memorial Symptom Assessment Scale.

Results: Both groups recorded similar sleep duration (7 hours) but the intervention group had fewer symptoms and significantly ( = .015) lower sleep disturbance scores (53.1 ± 14.5) than controls (71.9 ± 18.8). Participant feedback about the intervention was positive, although adherence to components of the intervention protocol was variable.

Conclusions: This pilot study provides evidence of the feasibility and preliminary efficacy of the SIP-AP intervention for reducing symptoms and improving sleep of antepartum patients during hospitalization. Further detailed evaluation of specific components of this protocol is warranted, and other types of hospitalized patients may benefit from unit-based modifications to this SIP-AP protocol.
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http://dx.doi.org/10.5664/jcsm.6846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695992PMC
December 2017

Effects of a liquefied petroleum gas stove intervention on pollutant exposure and adult cardiopulmonary outcomes (CHAP): study protocol for a randomized controlled trial.

Trials 2017 Nov 3;18(1):518. Epub 2017 Nov 3.

Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St. Room 555, Baltimore, MD, 21205, USA.

Background: Biomass fuel smoke is a leading risk factor for the burden of disease worldwide. International campaigns are promoting the widespread adoption of liquefied petroleum gas (LPG) in resource-limited settings. However, it is unclear if the introduction and use of LPG stoves, in settings where biomass fuels are used daily, reduces pollution concentration exposure, improves health outcomes, or how cultural and social barriers influence the exclusive adoption of LPG stoves.

Methods: We will conduct a randomized controlled, field intervention trial of LPG stoves and fuel distribution in rural Puno, Peru, in which we will enroll 180 female participants aged 25-64 years and follow them for 2 years. After enrollment, we will collect information on sociodemographic characteristics, household characteristics, and cooking practices. During the first year of the study, LPG stoves and fuel tanks will be delivered to the homes of 90 intervention participants. During the second year, participants in the intervention arm will keep their LPG stoves, but the gas supply will stop. Control participants will receive LPG stoves and vouchers to obtain free fuel from distributors at the beginning of the second year, but gas will not be delivered. Starting at baseline, we will collect longitudinal measurements of respiratory symptoms, pulmonary function, blood pressure, endothelial function, carotid artery intima-media thickness, 24-h dietary recalls, exhaled carbon monoxide, quality-of-life indicators, and stove-use behaviors. Environmental exposure assessments will occur six times over the 2-year follow-up period, consisting of 48-h personal exposure and kitchen concentration measurements of fine particulate matter and carbon monoxide, and 48-h kitchen concentrations of nitrogen dioxide for a subset of 100 participants.

Discussion: Findings from this study will allow us to better understand behavioral patterns, environmental exposures, and cardiovascular and pulmonary outcomes resulting from the adoption of LPG stoves. If this trial indicates that LPG stoves are a feasible and effective way to reduce household air pollution and improve health, it will provide important information to support widespread adoption of LPG fuel as a strategy to reduce the global burden of disease.

Trial Registration: ClinicalTrials.gov, ID: NCT02994680 , Cardiopulmonary Outcomes and Household Air Pollution (CHAP) Trial. Registered on 28 November 2016.
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http://dx.doi.org/10.1186/s13063-017-2179-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5670728PMC
November 2017

Patterns of Symptoms of Perinatal Depression and Stress in Late Adolescent and Young Adult Mothers.

J Obstet Gynecol Neonatal Nurs 2017 Nov - Dec;46(6):814-823. Epub 2017 Sep 6.

Objective: To compare symptoms of depression, maternal adjustment, and perceived stress in late adolescent and young adult mothers and to examine the patterns of these symptoms during the first 3 months after birth.

Design: Secondary analysis of existing longitudinal data.

Setting: San Francisco Bay Area, with participants in their home environments.

Participants: Ethnically diverse women expecting their first infants recruited during the third trimester from childbirth education classes and antenatal clinics. The final sample included 34 participants in the late adolescent group (18-20 years) and 48 participants in the young adult group (21-24 years).

Methods: The Center for Epidemiologic Studies Depression Scale was used to assess depression symptoms, the Maternal Adjustment and Maternal Attitudes Scale was used to assess maternal adjustment, and the 10-item Perceived Stress Scale was used to assess perceived stress. Repeated-measures analyses of variance were used to examine changes over time in depression, maternal adjustment, and perceived stress scores.

Results: Compared with young adult participants, late adolescent participants had greater mean depression scores (F = 8.02, p = .006) and perceived stress scores (F = 9.45, p = .003) at all time points. Scores for maternal adjustment could not be compared because of the low internal validity of the instrument.

Conclusion: Our results indicated that late adolescent mothers may have more symptoms of depression and stress in late pregnancy and the early postpartum period than young adult mothers. Clinicians in maternity and pediatric settings should be vigilant in screening for depression and stress in this vulnerable population during their transitions to motherhood.
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http://dx.doi.org/10.1016/j.jogn.2017.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682221PMC
July 2018

Isolated Peripheral Nerve Palsies in Thoracic Outlet Syndrome.

Ann Vasc Surg 2017 Oct 30;44:423.e3-423.e5. Epub 2017 May 30.

Department of Vascular Surgery, Black Country Vascular Network, Dudley, UK. Electronic address:

Thoracic outlet syndrome (TOS) poses a difficult diagnostic entity with varied etiology and clinical presentation. We present a 35-year-old gentleman with unilateral long thoracic nerve palsy and contralateral subscapular paralysis caused by aberrant scalenus medius anatomy. TOS ought to be considered in patients presenting with isolated nerve palsies.
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http://dx.doi.org/10.1016/j.avsg.2017.05.020DOI Listing
October 2017

Symptom Experience in Late Pregnancy.

J Obstet Gynecol Neonatal Nurs 2017 Jul - Aug;46(4):508-520. Epub 2017 May 23.

Objective: To evaluate the frequency, severity, distress, and correlates of common and rare symptoms reported by nulliparous women during the last month of pregnancy.

Design: Secondary cross-sectional analysis of data obtained in a larger randomized clinical trial.

Setting: San Francisco Bay area.

Participants: Nulliparous, ethnically diverse, predominantly low-income pregnant women 18 to 47 years of age (N = 151).

Methods: Participants at or beyond 36 weeks gestation used the Memorial Symptom Assessment Scale (MSAS) to provide self-reports of general symptom experience. Other symptom measures were also completed for comparison. Demographic characteristics, including gestational weight gain, were also collected. Gestational weight gain was categorized in relation to the Institute of Medicine's 2009 recommendations for weight gain during pregnancy.

Results: Women endorsed an average of 10.6 ± 5.6 symptoms on the MSAS. Prevalent symptoms (reported by at least half the sample) included lack of energy, pain, difficulty sleeping, worrying, irritability, drowsiness, shortness of breath, and nervousness. Among the women who reported these symptoms, relatively few described them as occurring with high frequency or severity or as causing much distress. One of the most prevalent symptoms (reported by 68% of women) was difficulty sleeping, which also had among the greatest ratings for frequency, severity, and distress. Although few maternal characteristics were associated with symptom experience, women who gained more weight than the Institute of Medicine's recommendation had worse MSAS total scores than women who gained the recommended amount or less.

Conclusion: In nulliparas, symptom frequency, severity, and distress varied and were related to excessive gestational weight gain.
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http://dx.doi.org/10.1016/j.jogn.2017.03.007DOI Listing
April 2018

Leukocyte Telomere Length in Postmenopausal Women.

J Obstet Gynecol Neonatal Nurs 2017 Jul - Aug;46(4):567-575. Epub 2017 May 20.

Objective: To compare leukocyte telomere length (LTL) by race and describe demographic, health, and psychosocial factors associated with LTL in postmenopausal women.

Design: Descriptive study with comparative analyses and correlations.

Setting: Data were collected at the University of California-San Francisco, San Francisco Clinical and Translational Science Institute.

Participants: Thirty-nine African American and White postmenopausal women between 58 and 65 years of age (mean age = 61.3 ± 1.83 years).

Methods: Measures included demographics, blood pressure, anthropometrics, scores on the Perceived Stress Scale and the Center for Epidemiologic Studies-Depression, and blood samples for LTL.

Results: African American women (n = 14) had greater PSS-10 and CES-D scores, greater blood pressure, and greater body mass index than White women (n = 25; p < .05), but LTL did not significantly differ between the two groups. Age was inversely related to LTL (r = -.355, p < .05). After age and race were controlled, fewer children (p = .005) and greater perceived stress (p = .036) were related to shorter LTL.

Conclusion: Findings from this small sample support the association between age and LTL. The association between perceived stress, number of children, and shorter LTL in postmenopausal women requires further research and replication of findings in a larger, more diverse sample.
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http://dx.doi.org/10.1016/j.jogn.2017.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609731PMC
April 2018

Cytokine polymorphisms are associated with daytime napping in adults living with HIV.

Sleep Med 2017 Apr 20;32:162-170. Epub 2017 Jan 20.

Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, CA, USA.

Objective/background: Daytime napping longer than one hour has been associated with an increased risk for all-cause mortality. Associations between cytokine polymorphisms and daytime napping in chronic illnesses such as HIV, however, have not been well described. The purpose of this study was to examine cytokine polymorphisms associated with long daytime napping in adults living with HIV.

Methods: A cross-sectional analysis was conducted using a convenience sample of 257 adults living with HIV. Daytime napping was assessed with wrist actigraphy data collected over three days. Participants categorized as long nappers (≥60 min) were compared to short nappers and non-nappers (<60 min). Single nucleotide polymorphisms (SNPs) for 15 candidate genes involved in cytokine signaling were analyzed. Genes included: interferon-gamma (IFNG), IFNG receptor 1 (IFNGR1), interleukins (IL1B, IL1R, IL1R2, IL2, IL4, IL6, IL8, IL10, IL13, IL17A), nuclear factors of kappa light polypeptide gene enhancer in B cells (NFKB1 and NFKB2), and tumor necrosis factor alpha (TNFA).

Results: After adjusting for relevant demographic and clinical characteristics, long daytime napping was associated with 12 SNPs from seven genes: 1) IFNG rs2069728; 2) IL1B rs1143642, rs1143627, and rs16944; 3) IL2 rs2069763; 4) IL6 rs4719714, rs1554606, and rs2069845; 5) IL17A rs3819024 and rs8193036; 6) NFKB1 rs4648110; and 7) NFKB2 rs1056890.

Conclusions: Cytokine genetic variations may have a role in physiological regulation of daytime napping as well as nocturnal sleep. Cytokine polymorphisms associated with long daytime napping could help identify adults with HIV who may benefit from targeted therapeutic interventions.
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http://dx.doi.org/10.1016/j.sleep.2016.12.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628054PMC
April 2017

Sleep disruption and duration in late pregnancy is associated with excess gestational weight gain among overweight and obese women.

Birth 2017 06 15;44(2):173-180. Epub 2017 Feb 15.

Department of Family Health Care Nursing, University of California, San Francisco, CA, USA.

Background: Poor sleep during pregnancy has been associated with poorer birth outcomes. High body mass index (BMI) is often associated with poor sleep, but little is known about the relationship between gestational weight gain and sleep in late pregnancy. The purpose of this study was to evaluate the relationships of both gestational weight gain and pre-pregnancy BMI to objective and subjective measures of sleep during late pregnancy.

Methods: Pregnant women (n=128) were recruited from prenatal clinics and childbirth classes primarily serving low-income women. Their sleep (disruption and duration) was objectively assessed in their last month of pregnancy with 72 hours of wrist actigraphy monitoring. Their perceived sleep quality was assessed with the Pittsburgh Sleep Quality Index. Pre-pregnancy and late pregnancy height and weight were assessed by self-report and used to calculate BMI and gestational weight gain, which were then grouped into standardized categories.

Results: Mean Pittsburgh Sleep Quality Index score was 6.8 ± 3.1 (range 2-16). Sixty percent had excess gestational weight gain and it was associated with poorer perceived sleep quality, but was unrelated to objective measures of sleep duration and disruption. Pre-pregnancy BMI was unrelated to all sleep parameters. However, analyses of the interaction of pre-pregnancy BMI and gestational weight gain indicated that excess weight gain was associated with shorter sleep duration and more sleep disruption, but only among women who were overweight before pregnancy.

Conclusion: Pregnancy is an opportunity to promote long-term women's health with a better understanding of the relationship between weight management and healthy sleep habits.
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http://dx.doi.org/10.1111/birt.12277DOI Listing
June 2017

A Qualitative Study Exploring Community Yoga Practice in Adults with Rheumatoid Arthritis.

J Altern Complement Med 2017 Jun 11;23(6):487-493. Epub 2017 Jan 11.

3 University of California San Francisco School of Nursing , San Francisco, CA.

Objective: Yoga may improve physical function and reduce disease symptoms in adults with rheumatoid arthritis (RA). However, little is known about how patients with RA are practicing yoga in the community. The objective of this qualitative study was to explore community yoga practice characteristics and thoughts about yoga practice for adults with RA.

Design: Participants completed a semi-structured telephone interview with open-ended questions. Thematic analysis was used to analyze interview transcripts.

Participants: A convenience sample of 17 adults with rheumatologist-diagnosed RA who had participated in yoga within the past year were asked about the decision to start, continue, and stop yoga; the perceived benefits of yoga; components of yoga sessions; and general thoughts about yoga as it relates to RA.

Results: Although eight different styles of yoga were practiced, commonalities in yoga class components (such as stretching, strengthening, deep breathing, meditation, and positive messaging from the instructor) reveal examples of preferred types of yoga for patients with RA. Three main themes emerged, each with multiple subthemes: (1) motivators (physical fitness, influence of others, reduced price), (2) barriers (cost, symptom burden, class difficulty), and (3) benefits of yoga practice (mind-body, a tool for coping, pride/achievement, social, and "yoga meets you where you are").

Conclusion: In this study, patients with RA described how yoga practice helped improve physical and psychosocial symptoms related to their disease. Yoga practice, a dynamic exercise, encompassing many different styles, can provide many benefits for adults with RA; however, yoga may not be beneficial for every adult with RA.
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http://dx.doi.org/10.1089/acm.2016.0156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488310PMC
June 2017

Symptom Clusters Change Over Time in Women Receiving Adjuvant Chemotherapy for Breast Cancer.

J Pain Symptom Manage 2017 05 3;53(5):880-886. Epub 2017 Jan 3.

T32 Nursing Research Training in Symptom Management, University of California San Francisco, School of Nursing, San Francisco, California, USA.

Context: Patients with breast cancer receiving chemotherapy (CTX) experience multiple concurrent symptoms, but little is known about how symptoms change during and after treatment. Knowledge of the identity and trajectory of symptom clusters (SCs) would enhance measurement and management.

Objectives: We aimed to identify SCs and their change over time from baseline to completion of breast cancer CTX.

Methods: SCs were identified and assessed for change in 219 women from Nebraska at four times: baseline, during cycles #3 and #4 of CTX, and one month after finishing CTX. Ten symptoms were measured: two using the Hospital Anxiety and Depression Scale and eight using the Symptom Experience Scale. Exploratory factor analysis was conducted at each time point, then changes in SCs were evaluated at different times.

Results: Two SCs were identified before and after initiating CTX: gastrointestinal and treatment-related. The number and type of symptoms in each cluster differed over time. Clusters were dynamic during CTX with changes in the number and type of symptoms. Only one treatment-related SC, which consisted of fatigue, pain, and sleep disturbance, was identified after CTX completion.

Conclusion: SCs during CTX appear to be dynamic, changing over time from before until after CTX completion. Repeated assessments of SCs reveal symptoms that are present and when patients are most burdened and in need of additional support.
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http://dx.doi.org/10.1016/j.jpainsymman.2016.12.332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410185PMC
May 2017

Sleep Enhancement Training for Pregnant Women.

Obstet Gynecol 2016 11;128(5):964-971

Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, and Inner Health, Inc., San Diego, California.

Objective: To evaluate the feasibility and efficacy of a home-based cognitive-behavioral training program for sleep during late pregnancy.

Methods: A nonrandomized quasiexperimental sample of nulliparous women who received the intervention during pregnancy (n=25) was compared with two control groups (n=76 and n=48) from other intervention studies at similar postintervention time points: approximately 1 month before childbirth and 1-2 months after childbirth. The home-based Sleep Enhancement Training System for Pregnancy consisted of 4 weeks of sound-enhanced audio relaxation programs, readings, and daily sleep diaries. Both control groups received dietary recommendations for improving sleep. Sleep duration (total sleep time) and sleep disruption (wake after sleep onset) were measured using wrist actigraphy for a minimum of 48 hours on consecutive weekdays.

Results: The intervention group had significantly longer sleep duration and less sleep disruption than both control groups, particularly at the postpartum assessment. Intervention participants slept an average of 430 (95% confidence interval [CI] 397-464) minutes during pregnancy compared with 420 (95% CI 403-438) and 417 (95% CI 395-439) minutes for the two control groups. At the postpartum assessment, the intervention group slept 446 (95% CI 415-478) minutes compared with 390 (95% CI 373-408) and 370 (95% CI 348-393) minutes for those in the control groups. In terms of sleep disruption, women in the intervention group had 16.1% (95% CI 11.9-20.2%) wake after sleep onset during pregnancy, whereas women in the control groups had 13.4% (95% CI 11.2-15.5%) and 20.4% (95% CI 17.7-23.0%). Postpartum, the intervention group had 20.3% (95% CI 16.4-24.1%) wake after sleep onset compared with 26.6% (95% CI 24.5-28.8%) and 28.7% (95% CI 26.0-31.5%) among women in the control groups. Participant feedback about the intervention was generally positive, although intervention adherence was variable.

Conclusion: This study provides evidence of the feasibility and efficacy of the Sleep Enhancement Training System for Pregnancy intervention for enhancing sleep that typically worsens during late pregnancy and after childbirth.
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http://dx.doi.org/10.1097/AOG.0000000000001654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218630PMC
November 2016

The InterLACE study: Design, data harmonization and characteristics across 20 studies on women's health.

Maturitas 2016 Oct 4;92:176-185. Epub 2016 Aug 4.

Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.

Objectives: The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) project is a global research collaboration that aims to advance understanding of women's reproductive health in relation to chronic disease risk by pooling individual participant data from several cohort and cross-sectional studies. The aim of this paper is to describe the characteristics of contributing studies and to present the distribution of demographic and reproductive factors and chronic disease outcomes in InterLACE.

Study Design: InterLACE is an individual-level pooled study of 20 observational studies (12 of which are longitudinal) from ten countries. Variables were harmonized across studies to create a new and systematic synthesis of life-course data.

Main Outcome Measures: Harmonized data were derived in three domains: 1) socio-demographic and lifestyle factors, 2) female reproductive characteristics, and 3) chronic disease outcomes (cardiovascular disease (CVD) and diabetes).

Results: InterLACE pooled data from 229,054 mid-aged women. Overall, 76% of the women were Caucasian and 22% Japanese; other ethnicities (of 300 or more participants) included Hispanic/Latin American (0.2%), Chinese (0.2%), Middle Eastern (0.3%), African/black (0.5%), and Other (1.0%). The median age at baseline was 47 years (Inter-quartile range (IQR): 41-53), and that at the last follow-up was 56 years (IQR: 48-64). Regarding reproductive characteristics, half of the women (49.8%) had their first menstruation (menarche) at 12-13 years of age. The distribution of menopausal status and the prevalence of chronic disease varied considerably among studies. At baseline, most women (57%) were pre- or peri-menopausal, 20% reported a natural menopause (range 0.8-55.6%) and the remainder had surgery or were taking hormones. By the end of follow-up, the prevalence rates of CVD and diabetes were 7.2% (range 0.9-24.6%) and 5.1% (range 1.3-13.2%), respectively.

Conclusions: The scale and heterogeneity of InterLACE data provide an opportunity to strengthen evidence concerning the relationships between reproductive health through life and subsequent risks of chronic disease, including cross-cultural comparisons.
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http://dx.doi.org/10.1016/j.maturitas.2016.07.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378383PMC
October 2016

A Qualitative Understanding of Midlife Sources of Stress and Support in African-American Women.

J Natl Black Nurses Assoc 2016 Jul;27(1):24-30

African-American women suffer from disproportionate adverse health outcomes compared to women of other ethnicities living in the United States. It is suggested in the literature that chron- ic stress can be an antecedent to health disparity. The purpose of this study was to evaluate changes in perceived stress from late pre-menopause to post-menopause and to identify significant life stressors perceived by a cohort of African-American women. Retrospective and current data were used to evaluate perceived stress over time, sources of stress, and resources in a cohort of 15 African-American women. Mixed methodologies were utilized. Perceived stress scores were consistent over time. Six themes were identified in responses about stress: finances, caringforfamily members, relationships, personal health and aging, race and discrimination, and raising children. Understanding the role that unique life stressors play in the lives of African-American women is essential in anticipating the need for assistance and in implementing preventive strategies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090538PMC
July 2016

Psychometric Limitations of the Center for Epidemiologic Studies-Depression Scale for Assessing Depressive Symptoms among Adults with HIV/AIDS: A Rasch Analysis.

Depress Res Treat 2016 3;2016:2824595. Epub 2016 Mar 3.

Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA 94143, USA.

The Center for Epidemiological Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its psychometric properties have not been adequately evaluated among adults with HIV/AIDS. This study used an item response theory approach (Rasch analysis) to evaluate the CES-D's validity and reliability in relation to key demographic and clinical variables in adults with HIV/AIDS. A convenience sample of 347 adults with HIV/AIDS (231 males, 93 females, and 23 transgenders; age range 22-77 years) completed the CES-D. A Rasch model application was used to analyze the CES-D's rating scale functioning, internal scale validity, person-response validity, person-separation validity, internal consistency, differential item functioning (DIF), and differential test functioning. CES-D scores were generally high and associated with several demographic and clinical variables. The CES-D distinguished 3 distinct levels of depression and had acceptable internal consistency but lacked unidimensionality, five items demonstrated poor fit to the model, 15% of the respondents demonstrated poor fit, and eight items demonstrated DIF related to gender, race, or AIDS diagnosis. Removal of misfitting items resulted in minimal improvement in the CES-D's substantive and structural validity. CES-D scores should be interpreted with caution in adults with HIV/AIDS, particularly when comparing scores across gender and racial groups.
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http://dx.doi.org/10.1155/2016/2824595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794594PMC
April 2016

Psychometric Limitations of the Center for Epidemiologic Studies-Depression Scale for Assessing Depressive Symptoms among Adults with HIV/AIDS: A Rasch Analysis.

Depress Res Treat 2016 3;2016:2824595. Epub 2016 Mar 3.

Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA 94143, USA.

The Center for Epidemiological Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its psychometric properties have not been adequately evaluated among adults with HIV/AIDS. This study used an item response theory approach (Rasch analysis) to evaluate the CES-D's validity and reliability in relation to key demographic and clinical variables in adults with HIV/AIDS. A convenience sample of 347 adults with HIV/AIDS (231 males, 93 females, and 23 transgenders; age range 22-77 years) completed the CES-D. A Rasch model application was used to analyze the CES-D's rating scale functioning, internal scale validity, person-response validity, person-separation validity, internal consistency, differential item functioning (DIF), and differential test functioning. CES-D scores were generally high and associated with several demographic and clinical variables. The CES-D distinguished 3 distinct levels of depression and had acceptable internal consistency but lacked unidimensionality, five items demonstrated poor fit to the model, 15% of the respondents demonstrated poor fit, and eight items demonstrated DIF related to gender, race, or AIDS diagnosis. Removal of misfitting items resulted in minimal improvement in the CES-D's substantive and structural validity. CES-D scores should be interpreted with caution in adults with HIV/AIDS, particularly when comparing scores across gender and racial groups.
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http://dx.doi.org/10.1155/2016/2824595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794594PMC
April 2016

A Rasch Analysis of Assessments of Morning and Evening Fatigue in Oncology Patients Using the Lee Fatigue Scale.

J Pain Symptom Manage 2016 06 11;51(6):1002-12. Epub 2016 Mar 11.

School of Nursing, University of California, San Francisco, California, USA.

Context: To accurately investigate diurnal variations in fatigue, a measure needs to be psychometrically sound and demonstrate stable item function in relationship to time of day. Rasch analysis is a modern psychometric approach that can be used to evaluate these characteristics.

Objectives: To evaluate, using Rasch analysis, the psychometric properties of the Lee Fatigue Scale (LFS) in a sample of oncology patients.

Methods: The sample comprised 587 patients (mean age 57.3 ± 11.9 years, 80% women) undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer. Patients completed the 13-item LFS within 30 minutes of awakening (i.e., morning fatigue) and before going to bed (i.e., evening fatigue). Rasch analysis was used to assess validity and reliability.

Results: In initial analyses of differential item function, eight of the 13 items functioned differently depending on whether the LFS was completed in the morning or in the evening. Subsequent analyses were conducted separately for the morning and evening fatigue assessments. Nine of the morning fatigue items and 10 of the evening fatigue items demonstrated acceptable goodness-of-fit to the Rasch model. Principal components analyses indicated that both morning and evening assessments demonstrated unidimensionality. Person-separation indices indicated that both morning and evening fatigue scales were able to distinguish four distinct strata of fatigue severity.

Conclusion: Excluding four items from the morning fatigue scale and three items from the evening fatigue scale improved the psychometric properties of the LFS for assessing diurnal variations in fatigue severity in oncology patients.
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http://dx.doi.org/10.1016/j.jpainsymman.2015.12.331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902715PMC
June 2016

Medication adherence among transgender women living with HIV.

AIDS Care 2016 08 24;28(8):976-81. Epub 2016 Feb 24.

b Department of Family Health Care Nursing , University of California , San Francisco , CA , USA.

Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the US report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore the factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transgender women. This secondary analysis is based on data collected from the Symptom and Genetic Study that included a convenience sample of 22 self-identified transgender women, 201 non-transgender men, and 72 non-transgender women recruited in northern California. Self-reported medication adherence was assessed using the AIDS Clinical Trials Group Adherence Questionnaire. Gender differences in demographic and clinical variables were assessed, as were differences between transgender women reporting high and low adherence. Transgender women had lower adherence to medications compared to non-transgender males and non-transgender females (p = .028) and were less likely to achieve viral suppression (p = .039). Within the transgender group, Black/African-Americans reported better adherence than participants who were Whites/Caucasian or other races (p = .009). Adherence among transgender women was unrelated to medication count and estrogen therapy, but consistent with other reports on the HIV population as a whole; transgender women with high adherence were more likely to achieve viral suppression compared to the transgender women with low adherence. Despite the high incidence of HIV infection in the transgender population, few studies focus on TWLWH, either in regard to their adherence to antiretroviral therapies or to their healthcare in general. To address ongoing health disparities, more studies are needed focusing on the transgender population's continuum of care in HIV therapies.
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http://dx.doi.org/10.1080/09540121.2016.1146401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917432PMC
August 2016

Bladder Symptoms in the Early Menopausal Transition.

J Womens Health (Larchmt) 2016 05 7;25(5):457-63. Epub 2016 Jan 7.

4 Department of Family Health Care Nursing, University of California , San Francisco, California.

Purpose: Bladder symptoms are common in women and result in use of healthcare resources and poor quality of life. Bladder symptoms have been linked to age and menopause, but debate exists in the literature. This article examines factors associated with bladder symptoms and compares women in late reproductive stage with those in menopausal transition.

Materials And Methods: We analyzed cross-sectional data from a prospective cohort study of midlife women (mean age, 48; range, 44-54 years) in northern California. The sample consisted of 158 women in late reproductive stage or menopause transition. Assessments included anthropometrics, menstrual cycle lengths and symptoms, urine samples for follicle-stimulating hormone level, and self-reported health perception and depressive symptoms. Analyses included descriptive bivariate statistics, group comparisons, and regression models.

Results: The most common bladder symptoms were nocturia (72%) at least once per night and urinary incontinence (50%) at least once per week. Incontinence was less prevalent in African American women compared to European Americans and Latinas (p = 0.001) and more prevalent in late reproductive stage than in menopause transition (p = 0.024). Controlling for age, women in late reproductive stage were more likely to report nocturia compared to those in menopause transition. Reproductive stage (p = 0.016), higher body mass index (p = 0.007), and race (p = 0.017) contributed to the variance in weekly nighttime urinary frequency.

Conclusion: Bladder symptoms were associated with reproductive stage. Women in late reproductive stage were more likely to experience nocturia and incontinence than those in menopause transition. The higher rates of nocturia and incontinence in late reproductive stage are intriguing. Future studies should include analysis of pelvic organ prolapse degree and other structural differences.
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http://dx.doi.org/10.1089/jwh.2015.5370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876519PMC
May 2016