Plasma cortisol and neuropeptide Y in female victims of intimate partner violence

BACKGROUND

The experience of intimate partner violence (physical and sexual violence) has been linked to psychiatric disorders such as posttraumatic stress disorder, yet data on the neuroendocrine profile in this population is sparse. This study sought to examine baseline plasma cortisol and neuropeptide Y (NPY) levels in female victims of intimate partner violence (IPV).

METHODS

Morning plasma samples were collected for cortisol and NPY determination in 22 women with histories of IPV (10 with current PTSD, 12 without current or lifetime PTSD) and 16 non-abused controls.

RESULTS

Mean cortisol levels were significantly lower in IPV subjects compared with controls, but did not distinguish IPV subjects with and without PTSD. There were no significant differences in mean NPY levels between the groups. Neither cortisol nor NPY levels were significantly correlated with PTSD symptoms.

CONCLUSIONS

These preliminary findings suggest that victims of IPV, like women traumatized by childhood abuse, may be characterized by alterations in hypothalamic-pituitary-adrenal axis functioning, however, further study is needed to identify specific stress system disturbances in this group.

Cognitive difficulties and posttraumatic stress disorder in female victims of intimate partner violence

Subjective cognitive complaints of women exposed to intimate partner violence (IPV) and nonabused women were examined using the Cognitive Difficulties Scale (CDS). Cognitive complaints were compared among victims of IPV with a lifetime diagnosis of posttraumatic stress disorder (PTSD) (PTSD+; n=20), victims of IPV without lifetime PTSD (PTSD-; n=21), and a nonabused comparison group (n=22). The results indicated that both the PTSD+ and PTSD- groups had significantly higher levels of self-perceived cognitive difficulties than nonabused women. Furthermore, PTSD symptom severity was found to be positively correlated with self-perceived cognitive difficulties (r=.47). Further research is needed to determine whether cognitive complaints are associated with exposure to IPV, with the subsequent development of PTSD, or with other not yet understood factors. Furthermore, additional work is needed to resolve whether cognitive complaints are accompanied by objective evidence of cognitive dysfunction in victims of IPV.

Meta analysis: effects of interventions on premature infants feeding

Nipple feeding of premature infants presents a challenge to neonatal nurses who are trying to prepare the infants for eventual discharge from the hospital. To determine what empirical evidence there was to support interventions that positively influence feeding performance and feeding efficiency a meta-analysis is presented. The effects of NPO, nasogastric tubes, different nipples, breast versus bottle feeding, gestational age, oral support, oral stimulation, and nonnutritive sucking on volume intake are evaluated. The results suggest that nursing care should: (a) consider the infant's gestational age; (b) maturational ability and development; (c) keep track of and attempt to minimize the length of time an infant is NPO; and (d) provide prefeeding oral stimulation and oral support.

Vitamin A and HIV infection: disease progression, mortality, and transmission

Among HIV-infected individuals, many nutritional factors that influence disease progress, mortality, and transmission are not well understood. Of particular interest is the role of vitamin A. The benefits of vitamin A have been recognized since ancient times by Egyptian physicians who successfully treated night blindness with vitamin A. Contemporary scientists have since recognized the importance of vitamin A and have provided evidence that it may help in repairing damaged mucosal surfaces; what remains unclear, however, is its role during HIV infection. In this review, we examine the evidence provided in both observational studies and randomized controlled trials that assessed the effect of vitamin A during HIV infection.

Randomized controlled trial assessing the effect of vitamin A supplementation on maternal morbidity during pregnancy and postpartum among HIV-infected women

OBJECTIVE

To determine whether low-cost treatment of HIV using vitamin A would be beneficial, we examined the effect of vitamin A supplementation on morbidity of HIV-1 infected women.

METHODS

We conducted a randomized, double blind placebo-controlled trial at King Edward VIII Hospital, in Durban, South Africa. In total, 312 HIV-seropositive pregnant women between 28 and 32 weeks' gestation were recruited into this trial. Patients were randomized to receive placebo or 5,000 IU retinyl palmitate and 30 mg beta-carotene daily. At delivery of their children, patients received placebo or 200,000 IU retinyl palmitate. The main outcome measures were pre- and postnatal report of HIV-related symptoms.

RESULTS

Vitamin A did not confer any significant beneficial effect on the report of either HIV or pregnancy-related symptoms during the pre- or postnatal period.

CONCLUSION

In this study of HIV-infected pregnant women, vitamin A supplementation given in doses designed to decrease mother-to-infant transmission did not result in significant beneficial effect on reported symptoms pre- or postnatally. Further investigation with larger number of participants, tailoring supplementation for specific clinical conditions, outside the context of pregnancy, is required to help clarify the possible clinical benefits of vitamin A.

Television and young Hispanic children's health behaviors

Television viewing patterns in preschool age Hispanic children were studied in order to explore the role of TV in the establishment of early childhood health behaviors. The television viewing habits and patterns of children and parents and parental coviewing, regulation, and encouragement practices were examined. Using the dimensions of regulation and encouragement, four parental typologies were established: laissez-faire, restrictive, promotive, and selective. Children in this study watched television 3-4 hours a day, half of which consisted of viewing adult shows. This amount of time is significantly higher than the guideline of less than 2 hours a day suggested by the American Academy of Pediatrics (AAP). Relationships between television viewing, injury behaviors, risk taking, and acculturation were established and implications for primary care, school, and community health care nursing are discussed.

Antenatal diagnosis of vesicouterine fistula

BACKGROUND

In pregnancy, vesicouterine fistulas usually are diagnosed postpartum after cesarean deliveries.

CASE

An 18-year-old woman, gravida 3, para 2, with two prior cesarean deliveries had pain and apparent rupture of membranes at 23 weeks' gestation. At 26 weeks' gestation, she developed increasing suprapubic pain and irregular contractions. Ultrasonographic findings included a small uterine defect and possible ballooning of membranes into her bladder. Cytoscopy showed ballooning of amnion into the bladder dome. A viable 900-g female infant was delivered by classic cesarean, the fistulous tract was excised, and the rupture sites were repaired.

CONCLUSION

Vesicouterine fistulas might be diagnosed antenatally. With continued contractions and associated uterine rupture, cesarean delivery can be done with excision of the fistulous tract and repair of the rupture sites.

Risk of repetition of a severe perineal laceration

OBJECTIVE

To compare the outcome of subsequent delivery in women with a history of a third- or fourth-degree laceration with outcomes in women without such a history.

METHODS

This retrospective study used a perinatal database and chart review from 1978 to 1995. Only women whose first delivery was at our institution at more than 36 weeks' gestation, vaginal singleton, vertex presentation, and birth weight greater than 2500 g, with a subsequent delivery were included. The women were grouped by presence or absence of a third- or fourth-degree (severe) perineal laceration in their first delivery. The subsequent delivery was analyzed for maternal age, weight, birth weight, gestational age, method of delivery, use of episiotomy, and occurrence of a severe laceration. Comparison of data was by Fisher exact and t tests.

RESULTS

Four thousand fifteen women met our starting criteria. In their first delivery, the average birth weight, use of instrumentation, and episiotomy rate were significantly higher in those women sustaining a severe laceration. When compared with women without a history of severe perineal laceration, women with such a history were at more than twice the risk for another in their subsequent delivery. The women at highest risk (21.4%) were those sustaining a laceration in their first delivery who underwent instrumental vaginal delivery with episiotomy in their subsequent delivery. When episiotomy or instrumental delivery was performed in the second vaginal birth, 52 (11.6%) of 449 women with a history of a severe perineal laceration sustained another, compared with 98 (6.5%) of 1509 without such a history (P < .001, odds ratio 1.9, 95% confidence interval 1.3, 2.7).

CONCLUSION

Women delivering their second baby, and in whom episiotomy or instrumentation is used, are at increased risk of severe perineal laceration compared with women delivery spontaneously.

Risk taking in young Hispanic children

INTRODUCTION

The purpose of this study was to examine risk taking and daring behavior in preschool-age Hispanic children. The study sought to describe aspects of children's personality, behavior, and culture that may inform us of their propensity to take risks that lead to injuries.

METHOD

Forty-five children (4 to 5 years of age) and their parents, drawn from a primary care practice, participated in the study. Instruments completed by the families included the Acculturation Scale. Child Shyness Report, Injury Report, and the Injury Behavior Checklist. Children were interviewed about risk taking and daring behavior using a projective technique (Child Sensation Seeking Profile).

RESULTS

These children, irrespective of gender and socioeconomic status, reported similar rates of daring and risk taking behavior. Injury behaviors were not predicted by personality profiles of shyness or the child's self-report of risk taking and daring behavior. Actual injuries increased with higher levels of acculturation, but children's injury behaviors reported by parents were low in comparison with other populations. Discrepancies were observed between parental perception and report of children's injury behavior and children's expressed preferences in some domains of daring and risky behavior.

DISCUSSION

Primary care providers must consider ethnic differences in rates and causes of injury when developing interventions and injury prevention programs. PNPs can use these findings to better meet the health promotion goals of Healthy Children 2000.

Childhood nutrition

This review focuses on the research in normative nutrition for children aged 2 to 12, published from 1985 to 1996. The chapter uses a primary prevention framework and the Healthy People 2000 (Public Health Service, 1990) objectives to identify and review those areas relevant for childhood health promotion and nursing practice. Current research demonstrates that food intake in early childhood is causally linked to health-related problems later in life, therefore obesity and cardiovascular research are highlighted in this review. Environmental and societal factors affect the nutritional health of children, thus the contribution of the media, poverty, cultural, and family practices are also reviewed. The chapter concludes with a summary of strengths and weaknesses of the body of research and suggestions for a nursing agenda in the area of childhood nutrition.

Intrauterine growth restriction: identification and management

Intrauterine growth restriction (IUGR) is a common diagnosis in obstetrics and carries an increased risk of perinatal mortality and morbidity. Identification of IUGR is crucial because proper evaluation and management can result in a favorable outcome. Certain pregnancies are at high risk for growth restriction, although a substantial percentage of cases occur in the general obstetric population. Accurate dating early in pregnancy is essential for a diagnosis of IUGR. Ultrasound biometry is the gold standard for assessment of fetal size and the amount of amniotic fluid. Growth restriction is classified as symmetric and asymmetric. A lag in fundal height of 4 cm or more suggests IUGR. Serial ultrasonograms are important for monitoring growth restriction, and management must be individualized. General management measures include treatment of maternal disease, good nutrition and institution of bed rest. Preterm delivery is indicated if the fetus shows evidence of abnormal function on biophysical profile testing. The fetus should be monitored continuously during labor to minimize fetal hypoxia.

Risk-taking in preschool children

This study was designed to characterize preschool-age children who engage in daring, risk-taking behaviors. Seventy-four children (39 males, 35 females) and their mothers from a wide range of socioeconomic strata participated. Children who described themselves as high in risk-taking were generally males, had higher accident and injury rates, and had parents whose assessments of their children's risk-taking activities were congruent with their own. Contrary to our expectations, however, risk-taking children did not appear to be more than ordinarily impulsive, which suggests that risk-taking is engaged in contemplatively (i.e., with some caution) by some youngsters and need not result in serious mishaps. Cognitive ability was found to be a codependent predictor of risk-taking for boys. Parents and clinicians will find it useful to know that risk-taking is a multidimensional phenomenon, not a unitary behavior or personality trait and that the Injury Behavior Checklist would be a valuable tool for screening selected populations.

Determination of zafirlukast, a selective leukotriene antagonist, human plasma by normal-phase high-performance liquid chromatography with fluorescence detection

A high-performance liquid chromatographic (HPLC) method was developed for the determination of zafirlukast, a selective peptide leukotriene receptor antagonist, in human plasma. Zafirlukast and the internal standard, ICI 198 707, were extracted from deproteinated plasma samples using large reservoir C18 solid-phase extraction columns and analyzed by normal-phase liquid chromatography with fluorescence detection. The method had a lower limit of quantitation of 0.75 ng/ml and a linear calibration curve in the range of 0.75 to 200 ng/ml. The absolute recovery of zafirlukast was > 90%, and the within-day and between-day relative standard deviations were < 9%. The utility of the method in the characterization of the plasma concentration-time profiles of zafirlukast in clinical studies was demonstrated.

Are children's early emotions antecedents to risk taking?

PURPOSE

To explore the processes by which early emotional experiences affect behavior and to investigate the use of basic development characteristics to guide primary care.

METHOD

A randomized cohort of 74 children from a wide range of socio-economic classes were followed from infancy until 54 months of age. Children were assessed at 2 days, 12, 18 and 54 months by laboratory tests and maternal report.

RESULTS

The personality characteristic of inhibition/shyness appeared to be an enduring trait from infancy through the preschool years. However, findings did not support the view that early personality variables (e.g., avidity, shyness, security) alone predict risk taking during later years.

CONCLUSIONS

Nurses offering safety counseling about risk taking in order to minimize injuries during early childhood should consider personality concepts to be multi-dimensional. Infant and toddler profiles should not be considered solely predictive of later behavior.

Clinical utility of the CERAD word list memory test

The word list memory test from the Consortium to establish a registry for Alzheimer's disease (CERAD) neuropsychological battery (Morris et al. 1989) was administered to 230 psychiatric outpatients. Performance of a selected, age-matched psychiatric group and normal controls was compared using an ANCOVA design with education as a covariate. Results indicated that controls performed better than psychiatric patients on most learning and recall indices. The exception to this was the savings index that has been found to be sensitive to the effects of progressive dementias. The current data are compared and integrated with published CERAD data for Alzheimer's disease patients. The CERAD list memory test is recommended as a brief, efficient, and sensitive memory measure that can be used with a range of difficult patients.

Experience in the design and use of isolator systems for sterility testing

The use of isolator systems for sterility testing is on the increase. Prior to installation and validation careful consideration must be given to the type of barrier to be used, and the design of the facility which will house the barrier system. The validation of these systems requires development and testing of the sterilization cycle. Vapor phase hydrogen peroxide has proven to be efficacious in this application, and examples of sterilization cycle development are presented in this paper. Also of concern is the penetration of sterilant into test articles, media and supplies.

Effects of melatonin on water metabolism and renal function in male Syrian hamsters (Mesocricetus auratus)

The pineal indoleamine, melatonin, has been shown to influence many physiological systems within the mammalian body. Few studies, however, have examined the influence of melatonin on renal function. This study investigated the effects of melatonin on water metabolism and renal function. Young adult male Syrian hamsters were maintained on a long photoperiod (LD 14:10) in metabolic cages. The animals received daily (1700) injections of either control vehicle or 25 micrograms of melatonin for 85 consecutive days. Melatonin administration resulted in significant increases in water consumption and urine production. Water budgets were also significantly influenced by melatonin, as were urinary osmolality, urinary sodium, and potassium concentrations, but urinary calcium concentrations were essentially unaltered. When excretion rates for sodium, potassium, and calcium were calculated, no differences were observed between the vehicle control and melatonin-treated groups. Injections of melatonin also significantly decreased plasma antidiuretic hormone (ADH). These results demonstrate that afternoon injections of melatonin can alter renal function, which may involve direct (i.e., on ADH secretion and/or thirst mechanisms) or indirect (i.e., behavioral) effects.

Technetium carboxylate complexes--III. A new synthetic route to hexakis-(isonitrile) technetium(I) salts

Hexakis(isonitrile)technetium(I) cations have been prepared from carboxylate based technetium starting materials. The following ligands have been employed: t-butyl, n-butyl, cyclohexyl, and benzyl isonitrile. The products have been characterized by u.v.-visible and i.r. spectroscopy, cyclic voltammetry, fast atom bombardment mass spectrometry and electrophoresis.

A formate based precursor for the preparation of technetium complexes

Tc-formate complexes have been prepared by electrolytic, stannous, and borohydride reduction of pertechnetate in formate buffer. Individual Tc-formate complexes were isolated from reaction mixtures with silica bonded phase anion-exchange HPLC. The predominate air stable red Tc-formate complex has a negative charge, an absorption maximum at 536 nm, and a molecular weight between 100 and 300 dalton. The isolated major Tc-formate complex was found to react with isocyanide, diphosphonate, and various nitrogenous ligands. The relevant use of Tc-formate complexes as synthetic precursors to other technetium complexes is seen as being beneficial to the understanding of technetium ligand substitution.