Papers by Margaret Heitkemper
Neurogastroenterology and Motility, Mar 19, 2016
Effect of Early Low-Intensity Exercise on Rat Hind-Limb Muscles Following Acute Ischemic Stroke
Biological Research For Nursing, 2006
This study examined the effects of daily low-intensity exercise following acute stroke on mass, T... more This study examined the effects of daily low-intensity exercise following acute stroke on mass, Type I and II fiber cross-sectional area, and myofibrillar protein content of hind-limb muscles in a rat model. Adult male Sprague-Dawley rats were randomly assigned to 1 of 4 groups (n = 7-9 per group): stroke (occlusion of the right middle cerebral artery [RMCA]), control (sham RMCA procedure), exercise, and stroke-exercise. Beginning 48 hours post-stroke induction/sham operation, rats in the exercise group had 6 sessions of exercise in which they ran on a treadmill at grade 10 for 20 min/day at 10 m/min. At 8 days poststroke, all rats were anesthetized and soleus, plantaris, and gastrocnemius muscles were dissected from both the affected and unaffected sides. After 6 sessions of exercise following acute ischemic stroke, the stroke-exercise group showed the following significant (p < .05) increases compared to the stroke-only group: body weight and dietary intake, muscle weight of affected soleus and both affected and unaffected gastrocnemius muscle, Type I fiber cross-sectional area of affected soleus and both affected and unaffected gastrocnemius muscle, Type II fiber cross-sectional area of the unaffected soleus, both affected and unaffected plantaris and gastrocnemius muscle, Type II fiber distribution of affected gastrocnemius muscle, and myofibrillar protein content of both affected and unaffected soleus muscle. Daily low-intensity exercise following acute stroke attenuates hind-limb muscle atrophy in both affected and unaffected sides. The effects of exercise are more pronounced in the soleus and gastrocnemius as compared to the plantaris muscle.
Nursing Research, Sep 1, 2004
Background: Stroke patients experience functional changes resulting from muscle atrophy related t... more Background: Stroke patients experience functional changes resulting from muscle atrophy related to disuse, lack or limited neuronal stimulation, and undernutrition. Acute ischemic stroke is assumed to induce muscle atrophy. However, there is little information regarding muscle changes after acute stroke. The purpose of this study was to examine the effect of inactivity and undernutrition after acute stroke on mass, myofibrillar protein content, and Types I and II fiber crosssectional areas of rat hindlimb muscles. Methods: Adult male Sprague-Dawley rats (body weight, 240-270 g) were randomly assigned to one of three groups: a stroke group (n ϭ 7) that had occlusion of the right middle cerebral artery, a control group (n ϭ 7) that underwent a sham right middle cerebral artery procedure, and an undernourished group (n ϭ 9) that was pair-fed to match the intake of stroke rats. Food and water intake as well as body weight were measured daily. The rats were anesthetized 7 days after occlusion or sham occlusion, after which the soleus (Type I), plantaris (Type II), and gastrocnemius (Type II) muscles were dissected from both the affected and unaffected sides. The brain was sectioned to identify cerebral infarction in the stroke group. Body weight, food intake, muscle weight, fiber type distribution, cross-sectional area, and myofibrillar protein content of the dissected muscles were determined. The stroke group at 7 days after ischemic stroke showed significant decreases (p Ͻ .05), as compared with the control rats, in diet intake and body weight, muscle weight of affected gastrocnemius, Type I fiber cross-sectional area of the affected soleus muscle, Types I and II fiber cross-sectional areas and Type II fiber distribution of the unaffected soleus muscle, and myofibrillar protein content of both the affected and unaffected soleus muscles. As compared with the control group, the undernourished group showed significant decreases (p Ͻ .05) in diet intake and body weight, Type I fiber cross-sectional area of the affected soleus muscle, Types I and II fiber cross-sectional areas and Type II fiber distribution of the unaffected soleus muscle, Type I fiber distribution of the affected gastrocnemius muscle, and myofibrillar protein content of both the affected and unaffected soleus muscles. As compared with the undernourished group, the stroke group showed significant decreases (p Ͻ .05) in muscle weight and Type II fiber distribution of the affected gastrocnemius muscle. There were no differences in muscle characteristics between the affected and unaffected hindlimb muscles at 7 days after ischemic stroke. and unaffected sides after acute stroke, with Type I muscle changes more apparent than Type II changes.
International Journal of Environmental Research and Public Health, Mar 4, 2022
Mo2014 ASSOCIATIONS BETWEEN THE FREQUENCY AND SEVERITY OF HEADACHES AND ABDOMINAL PAIN IN CHILDREN WITH PAIN-RELATED DISORDERS OF GUT-BRAIN INTERACTION
Gastroenterology
BACKGROUND Despite pharmacological treatment, individuals with inflammatory bowel disease (IBD) e... more BACKGROUND Despite pharmacological treatment, individuals with inflammatory bowel disease (IBD) experience a variety of symptoms, including abdominal pain, fatigue, anxiety, and depression. Few nonmedical self-management interventions are available for people with IBD. A validated comprehensive self-management (CSM) intervention is effective for patients with irritable bowel syndrome who can have symptoms similar to those of individuals with IBD. We created a modified CSM intervention tailored to individuals with IBD (CSM-IBD). The CSM-IBD is an 8-session program delivered over 8-12 weeks with check-ins with a registered nurse. OBJECTIVE The primary objective of this pilot study is to determine the feasibility and acceptability of study procedures and the CSM-IBD intervention and to evaluate preliminary efficacy on quality of life and daily symptoms for a future randomized controlled trial. Additionally, we will examine the association of socioecological, clinical, and biological fa...
Symptom management needs of patients with irritable bowel syndrome and concurrent anxiety and/or depression: A qualitative study
Journal of Advanced Nursing
AimsTo understand the experiences and needs of symptom management among individuals with irritabl... more AimsTo understand the experiences and needs of symptom management among individuals with irritable bowel syndrome and concurrent symptoms of anxiety and/or depression.DesignThis study used a qualitative descriptive research design.MethodsIndividuals with a diagnosis of irritable bowel syndrome and concurrent symptoms of anxiety and/or depression participated were recruited through an online ResearchMatch and a listserv. Semi‐structured interviews focused on symptoms and experiences with symptom management interventions conducted from June to August 2020. Interviews were transcribed and data were analysed based on thematic analysis.ResultsTwelve individuals participated in this study; all reported current irritable bowel syndrome and anxiety/depression symptoms. The data analysis cumulated with three themes related to symptom management: (a) irritable bowel syndrome negatively impacts physical and mental well‐being; (b) a trial and error approach to symptom management; and (c) challe...
Impact of COVID-19 on Individuals With Irritable Bowel Syndrome and Comorbid Anxiety and/or Depression
Journal of Clinical Gastroenterology, 2021
Goals: The goal of this study was to describe the influence of the COVID-19 pandemic on ability t... more Goals: The goal of this study was to describe the influence of the COVID-19 pandemic on ability to engage in activities and the influence on psychological distress and gastrointestinal symptoms among individuals with irritable bowel syndrome (IBS) and comorbid anxiety and/or depression. Background: Individuals with IBS and comorbid anxiety and/or depression report increased symptoms and decreased quality of life compared with individuals with IBS alone. The current COVID-19 pandemic has the potential to further influence symptoms among individuals with IBS and comorbid anxiety and/or depression. Study: Individuals who met the Rome-IV IBS criteria and reported mild to severe anxiety and/or depression were included. Participants completed an online survey with questions about anxiety, depression, impact of COVID on activities and symptoms, and demographics. Results: Fifty-five individuals participated in the study. The COVID-19 pandemic most commonly influenced their ability to spend ...
Biological Research For Nursing, 2020
Background: Young to middle-aged women are more likely than men to be diagnosed with irritable bo... more Background: Young to middle-aged women are more likely than men to be diagnosed with irritable bowel syndrome (IBS). Immune dysfunction may be present in IBS, however, few studies have tested whether hormonal contraceptive use is linked to inflammatory markers. The purpose of this study was to compare cytokine levels between women (ages 18–45) with and without IBS and with and without hormonal contraceptive use and to examine the relationships of cytokine levels to IBS gastrointestinal (GI) and non-GI symptoms within those using and not using hormonal contraceptives. Methods: Seventy-three women with IBS and 47 healthy control women completed questionnaires (demographics, hormonal contraceptive use) and kept a 28-day symptom diary. Fasting plasma and LPS-stimulated pro-inflammatory (IL-1β, IL-6, IL-12p40, IL-12p70, IL-8, and TNF-α) and anti-inflammatory (IL-10) cytokines were assayed. Results: No differences were found in plasma or stimulated cytokine levels between IBS and control ...
Gastroenterology, 2020
Background: Polyethylene Glycol 3350 (PEG-3350) is an over the counter laxative commonly used to ... more Background: Polyethylene Glycol 3350 (PEG-3350) is an over the counter laxative commonly used to treat constipation in pediatric populations. Anecdotal reports of anxiety, lethargy, aggression, mood swings and obsessive compulsive behavior after administration of PEG 3350 have led to parental concerns. However, behavioral problems are common in children with constipation like anxiety, aggression, depression and increased emotional reactivity, and no data have linked PEG 3350 to behavioral changes. In a previous study, we did not find any effects of PEG-3350 on mouse behavior. However, behavior was assessed on multiple time points, which may confound results. Thus, a follow-up experiment was conducted in which behavior was assessed at only a single time point after laxative administration. Aim: Determine if PEG-3350 leads to anxiety-like behavior in male and female mice. Methods: Outbred CD1 mice (8 weeks old) were divided into 6 groups that received: PEG-3350 either at 1g/kg or 4 g/kg, magnesium citrate either at 450mg/kg or 600 mg/kg or water via daily oral gavage for two weeks. In addition, there was an unhandled control group that was not gavaged with vehicle or any of the treatments. Male and female mice were used (n=12 per group) for a total of 144 mice. Stool consistency was assessed 4-6 hours after gavage and was recorded on a scale from 0-3 with 0 indicating normal hard pellets, 1 indicating mildly soft stool, 2 indicating very soft stool, and 3 indicating watery stool. Mice were weighed daily during the gavage period. Behavior on the Light/Dark test, open field test, and elevated plus maze was assessed after 2 weeks of the gavage. Standard measures of anxiety-like behavior were scored during the 5 minutes of the tests. Results: PEG-3350 and magnesium citrate significantly changed stool consistency compared to water and control groups. Although female mice showed increased anxiety-like behavior in the open field task and elevated plus maze, neither PEG-3350 or magnesium citrate affected male or female behavior in the Light/Dark preference test (including latency to enter the dark, time spent in the dark, and number of transitions between light and dark chambers), the open field task (including time spent in the center/periphery, resting time, and distance traveled), or the elevated plus maze (number of entries, time spent in the open arm, and time spent in the closed arm). Conclusion: Daily administration of PEG-3350 does not significantly affect anxiety-like behavior or locomotor activity in male or female mice despite a sufficient laxative affect.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 15, 2018
Mobile health (mHealth) tools such as smartphone applications (apps) have potential to support sl... more Mobile health (mHealth) tools such as smartphone applications (apps) have potential to support sleep self-management. The objective of this review was to identify the status of available consumer mHealth apps targeted toward supporting sleep self-management and assess their functionalities. We searched four mobile app stores (iTunes Appstore, Android Google Play, Amazon Appstore, and Microsoft Appstore) using the terms "sleep", "sleep management," "sleep monitoring," and "sleep tracking." Apps were evaluated using the Mobile Application Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scores. We identified 2,431 potentially relevant apps, of which 73 met inclusion criteria. Most apps were excluded because they were unrelated to sleep self-management, simply provided alarm service, or solely played relaxation sounds in an attempt to improve sleep. The median overall MARS score was 3.1 out of 5, and more than ha...
Clinical and translational gastroenterology, Jan 3, 2016
Seventy percent of patients with irritable bowel syndrome (IBS) identify certain foods as trigger... more Seventy percent of patients with irritable bowel syndrome (IBS) identify certain foods as triggers for their symptom flare-ups. To help identify potential trigger foods, practitioners often rely on patient food and gastrointestinal (GI) symptom journaling. The aim of the study was to evaluate the feasibility and usability of a novel food and symptom journal app, specifically designed for patients with IBS. Secondary aims were to explore the effect of using the app on GI symptoms and to describe associations between diet and GI symptoms suggested by individual patient data. The feasibility and usability of the novel app was studied in 11 IBS patients (8 women), aged 21-65 years. Participants were asked to log GI symptoms (abdominal pain, bloating, diarrhea, constipation) using a 100-point color-graded sliding scale (green=none, red=severe) four times a day and to log every meal/snack they ate (at least three times a day) over a 2-week period. The app's feasibility as a data colle...
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 7, 2015
We developed a comprehensive self-management (CSM) program that combines cognitive behavioral the... more We developed a comprehensive self-management (CSM) program that combines cognitive behavioral therapy with relaxation and dietary strategies; 9 sessions (1 hr each) over 13 weeks were shown to reduce gastrointestinal symptoms and increase quality of life in a randomized trial of patients with irritable bowel syndrome (IBS), compared to usual care. The aims of this study were to describe strategies IBS patients selected and continued to use, 12 months after the CSM program began. We performed a cohort study to continue to follow 81 adults with IBS (87% female; mean age 45±15 years old) who received the CSM program in the previous clinical trial. During the last CSM session, participants selected strategies they intended to continue using to manage their IBS. CSM strategies were categorized into subthemes of diet (composition, trigger foods, meal size or timing, and eating behaviors), relaxation (specific relaxation strategies and lifestyle behaviors), and alternative thoughts (identi...
Journal of neurogastroenterology and motility, Jan 12, 2015
To determine if potential biomarkers can be used to identify subgroups of people with irritable b... more To determine if potential biomarkers can be used to identify subgroups of people with irritable bowel syndrome (IBS) who will benefit the most or the least from a comprehensive self-management (CSM) intervention. In a two-armed randomized controlled trial a CSM (n = 46) was compared to a usual care (n = 46) group with follow-up at 3 and 6 months post randomization. Biomarkers obtained at baseline included heart rate variability, salivary cortisol, serum interleukin-10, and lactulose/mannitol ratio. Linear mixed models were used to test whether these biomarkers predicted improvements in the primary outcomes including daily abdominal pain, Gastrointestinal Symptom Score and IBS-specific quality of life (QOL). The nurse-delivered 8-session CSM intervention is more effective than usal care in reducing abdominal pain, reducing Gastrointestinal Symptom Score, and enhancing QOL. Participants with lower nighttime high frequency heart rate variability (vagal modulation) and increased low fre...
Does the Effectiveness of Comprehensive Self Management Therapy for Ibs Vary with Age
ABSTRACT
Self-Management Strategies for Irritable Bowel Syndrome
Diagnosis and Clinical Management, 2013
Research in Nursing & Health, 1997
The purpose of this investigation was to compare self-reported sleep quality and psychological di... more The purpose of this investigation was to compare self-reported sleep quality and psychological distress, as well as somnographic sleep and physiological stress arousal, in women recruited from the community with self-reported medically diagnosed fibromyalgia (FM) to women without somatic symptoms. Eleven midlife women with FM, when compared to 11 asymptomatic women, reported poorer sleep quality and higher SCL-90 psychological distress scores. Women with FM also had more early night transitional sleep (stage 1) (p Ͻ 0.01), more sleep stage changes (p Ͻ 0.03) and a higher sleep fragmentation index (p Ͻ 0.03), but did not differ in ␣-EEG-NREM activity (a marker believed to accompany FM). No physiological stress arousal differences were evident. Less stable sleep in the early night supports a postulate that nighttime hormone (e.g., growth hormone) disturbance is an eitiologic factor but, contrary to several literature assertions, ␣-EEG-NREM activity sleep does not appear to be a specific marker of FM. Further study of mechanisms is needed to guide treatment options.
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Papers by Margaret Heitkemper