High hydroxycinnamic acids contents in fennel honey produced in Southern Italy

A total of 122 honey samples (Apis mellifera ssp. Ligustica) collected from Southern Italy were examined for floral identification by melissopalynological examination and for polyphenols detection by an LC-ESI-Orbitrap^TM -MS/MS method. The melissopalynological examination confirmed all the samples examined as fennel (Foeniculum vulgare) unifloral variety. The analytical method carried out for polyphenols detection showed satisfactory linearity and recovery values, achieved during the validation of the method. Very high amounts of flavonols (kaempferol and quercetin) and hydroxycinnamic acids (caffeic acid, chlorogenic acid and ferulic acid), were found in all the samples examined. Among the hydroxycinnamic acids group, caffeic acid showed the highest mean contents (865.90 ± 67.07 µg/kg). The results of this work confirmed the high presence of phenolic acids with strong free radical-scavenging activity in fennel products such as honey, suggesting their use to reduce oxidative stress.

Screening for C677T and A1298C MTHFR polymorphisms in patients with epilepsy and risk of hyperhomocysteinemia

Hyperhomocysteinemia can result from decreased methylenetetrahydrofolate reductase (MTHFR) enzyme activity, owing to genetic polymorphisms andor inadequate folate intake. This study was aimed at investigating the prevalence of C677T and A1298C MTHFR polymorphisms, and their impact on hyperhomocysteinemia in 95 epileptic patients and 98 controls. Double gradient-denaturing gradient gel electrophoresis screening revealed that the frequency of T677 polymorphic allele was similar between cases and controls (46.3% vs 42.3%), whereas that of C1298 allele was significantly higher in patients (30.5% vs 19.4%, p < 0.05). Significant differences between the two groups were also found for the frequencies of genotypes AA1298 (46.3% in cases vs 67.3% in controls, p < 0.01) and AC1298 (46.3% in cases vs 26.6% in controls, p < 0.01). Other genotype frequencies did not show any statistically significant differences. Haplotype frequencies significantly differed between the two groups. The CT677/AC1298 diplotype was significantly more frequent in epileptic patients than in controls (32.6% vs 18.4%, p < 0.05). Patients treated with enzyme-inducing antiepileptic drugs, having this diplotype and concomitant low folate concentration (i.e., < 3.4 nmol/L), exhibited plasma homocysteine levels significantly higher than normal values (27.1 +/- 2.44 micromol/L, p < 0.001). This increase, however, was lower than that observed in folate-deficient patients with diplotype TT677/AA1298 (41.3 +/- 3.41 micromol/L, p < 0.001). Indeed, these two diplotypes could be regarded as risk factors for hyperhomocysteinemia. Conversely, we found that the CC677/AA1298 diplotype was significantly more frequent in controls (p < 0.01), suggesting a protective role. Our study suggests that both C677T and A1298C MTHFR polymorphisms should be examined when assessing genetic risk factors of hyperhomocysteinemia in epilepsy.

Making evidence-based practice a reality in your institution

There are many barriers to ensuring that nursing practice is based on research evidence. This article provides several resources to help the practicing nurse identify what evidence is available upon which to make practice changes. Additionally, strategies for supporting change are discussed and a case study of one particular evidenced-based change--1:1 support by nurses for women in labor--is examined.

A Quality of Health Outcomes Model for guiding obstetrical practice

PURPOSE

To describe the application of the Quality of Health Outcomes Model, introduced by the American Academy of Nursing Expert Panel on Quality of Health Care, to obstetrical care, particularly second-stage labor.

ORGANIZING FRAMEWORK

The model is different from the more linear structure-process-outcome frameworks used in the past to a dynamic conceptualization of reciprocal relationships among the system, intervention, client, and outcome components. Analysis of these components can provide a comprehensive picture of the complexity of patient care decision making in hospital labor and delivery units.

CONCLUSIONS

Research findings indicate that interventions such as cesarean delivery and epidural analgesia may result in several significant quality of health outcomes for women that should receive increased attention. Uses of this model for shaping best practices among physicians and nurses and for setting directions for priorities in future interdisciplinary research and health policy are discussed.

Health promotion and risk reduction in Malawi, Africa, village women

OBJECTIVE

A train-the-trainer intervention was evaluated in which village leaders in Malawi, Africa, taught other villagers how to improve their health.

DESIGN

Health knowledge and reported health practices were compared before and after the educational intervention in 15 villages in Chimutu, Malawi, Africa.

SETTING

Surveys were completed by trained data gatherers in the village setting.

PATIENTS/PARTICIPANTS

All men and women of childbearing age who were present in the village when data collection occurred were asked to participate. There were 187 participants in the preintervention survey and 175 participants in the postintervention survey.

INTERVENTION

Seventy-six village women were trained, using low literacy techniques, to provide content on health promotion and risk reduction in pregnancy. Over 20,000 persons have received at least one health teaching session from the village trainers.

RESULTS

The intervention resulted in reported changes in prenatal and postpartum care and in more births occurring in the hospital or clinic. Some positive nutritional changes were reported, although few changes in beliefs about use of herbal medicines or about the use of witchcraft were reported.

CONCLUSIONS

A train-the-trainer approach is a sustainable intervention that appears to have positive benefits on the health of village women living in Malawi, Africa.

Postpartum smoking behaviors and immune response in mothers of term and preterm infants

Infants exposed to secondhand smoke, especially preterm infants with a very low birth weight (VLBW), have an increased risk for developing health problems. Smoking has been associated with numerous health problems in mothers and may reduce immune functioning as well. The purposes of this study were to examine smoking in postpartum mothers of term and preterm infants and to examine the relationship between smoking and immune status. Peripheral blood was drawn on 142 women at four data-collection points and tested for cotinine, immune cell phenotypes, and immune functioning. Overall, 39% of the participants smoked in the postpartum period, but 49% of mothers who delivered preterm infants smoked compared to only 28% of mothers who delivered term infants. There was no difference in cotinine levels between the smokers in both groups of postpartum mothers, nor was smoking related to immune phenotypes or immune function. Given the documented health risks to the mother and infant and the significant number of women who continue to smoke in the postpartum period, it is imperative that health care providers continue to assess smoking status and provide smoking-cessation counseling at every encounter.

International nursing: the past 25 years and beyond

International nursing has grown substantially in the last 25 years. Once practiced only during war time, with immigrant populations, or in peace time in consultative roles, international nursing is now common, with direct practice, education, consultation, and research collaboration as the roles in which nurses work across borders. A brief history of international nursing, forces that have influenced its growth, and an assessment of its future are discussed.

Autoregulation of cortical blood flow during surgery for ruptured intracranial aneurysms

BACKGROUND

Little information is available about the extent and the time course of possible impairment of cerebral circulation occurring after aneurysmal subarachnoid haemorrhage (SAH). The aim of this study was to correlate cerebral autoregulation, neurological impairment at surgery and timing of surgery in patients with ruptured intracerebral aneurysms.

METHODS

Cortical blood flow (CoBF) was measured intraoperatively by a thermal diffusion probe in 77 patients during surgery for ruptured supratentorial aneurysms, who were operated on at different time intervals after bleeding. An autoregulation index (AI), expressed as the ratio between the change in CoBF and the change of mean arterial blood pressure at the time of rising the systemic blood pressure after occlusion of the aneurysm(s), was determined in each case.

RESULTS

Among good-grade patients (WFNS grade I-II), those operated on days 0-2 after SAH had a significantly better autoregulatory response, compared either with patients who underwent surgery on days 3-7 after bleeding (p<0.01), or with those whose aneurysm was occluded more than 7 days after rupture (p<0.03). The mean AI of poor-grade patients (WFNS grade IV-V), who received surgery on days 0-2 after SAH, was significantly higher (p<0.01) compared with the corresponding value of good-grade patients. No significant difference was found between the mean AIs of patients who subsequently did, or did not, develop symptomatic vasospasm.

CONCLUSIONS

It is concluded that good-grade patients operated on within 48 hours after bleeding take advantage of a preserved autoregulatory function during controlled hypotension.

Maternal fatigue: implications of second stage labor nursing care

The parameters of fatigue have been studied in recent years in relation to women's health and the childbearing period. Less research emphasis has been placed on second stage labor, a period of time that can encompass considerable physiologic and psychologic fatigue. Consideration to minimizing second stage labor fatigue by altering conventional support practices is needed. This includes minimizing long periods of strong pushing or bearing down efforts in conjunction with sustained breath holding, particularly for women receiving epidural anesthesia. The potential sequelae of second stage labor fatigue, recommendations for practice changes, and new research directions are discussed.

Nutrition and exercise in overweight and obese postpartum women

This secondary analysis of a longitudinal, nonintervention study describes the nutritional and physical activity behavior of overweight and obese postpartum women and the differences in nutrition and physical activity when participants are evaluated according to four weight categories: underweight, normal weight, overweight, and obese. The sample consisted of 67 postpartal women [40 (60%) African American and 27 (40%) White] who gave birth vaginally to healthy term infants. No differences were present when overweight and obese women were compared with underweight and normal weight women relative to nutrition and physical activity. Nutritional imbalances were present for overweight and obese women relative to protein and fat intake. Overweight and obese postpartum women can be encouraged to lose weight using a nutritionally balanced approach by decreasing fat and protein intake, maintaining an adequate carbohydrate intake, and increasing their folacin intake.

Immune alterations associated with epidural analgesia for labor and delivery

PURPOSE

Epidural analgesia is frequently used for the laboring woman and commonly regarded as safe. The association of epidural analgesia with fever, in the absence of infection, in this population can result in unnecessary sepsis workups in both neonates and mothers. Studies in other populations of patients have found that epidural anesthesia may be associated with alterations in white blood cell count parameters. This study was designed to determine if epidural analgesia is associated with alterations in immune profile or immune function in healthy afebrile postpartum women.

DESIGN

This prospective quasi-experimental study examined a convenience sample of normal afebrile postpartum women in two groups for differences in immune profile and immune function based on whether they received epidural analgesia during labor and delivery.

METHODS

Mothers who agreed to participate in the study and met inclusion criteria had blood drawn for immune profile and immune function studies within 24 hours of their delivery. This study looked at immune phenotypic profile, lymphocyte proliferative response, and NK lysis assays.

RESULTS

No differences in immune profile or immune function were found based on administration of epidural analgesia.

CLINICAL IMPLICATIONS

Nurses can be confident that the white blood cell count and other phenotypic measures of leukocytes are not affected by epidural analgesia. Thus the epidural analgesic technique appears not to alter immune measures of infection in postpartum women. In evaluating fever in postpartum mothers and neonates, nurses should consider prior receipt of epidural analgesia and measures of immune profile. In addition to fever and white blood cell counts, other signs and symptoms of infection should also be evaluated in postpartum women when infection is suspected.

An expanded neonatal morbidity scale for premature infants

We revised a neonatal morbidity scale (the NMS) that has served as a means for comparison of neonatal illness in studies of high-risk neonates after initial hospital discharge. With an inception cohort approach, 89 premature infants at an urban university hospital were studied with the expanded scale (the ENMS). The original scale, published in 1983, was reworked and expanded based on advances in the diagnosis and management of neonates. A social risk scale was added. Linear and logistic regression analyses were used to judge validity of the newly revised scale and to examine its predictive ability for outcomes at six months of age. Concurrent validity was supported by the relationship between the ENMS-SRS and: birthweight (R2 = .54), gestational age (R2 = .50), length of stay (R2 = .47). Inter-rater reliability was .95. The ENMS, embodying a contemporary patient profile, is valid for a population of premature infants in a U.S. urban setting and has predictive validity for a few outcomes within six months of discharge from a special care unit.

Vulnerable infants: kinship care and health

Kinship care, a type of foster care provided by relatives, has expanded rapidly in the last decade. This descriptive prospective study was part of a larger study on the costs to families caring for a preterm infant. Of the 224 families interviewed, 12 families (13 infants) participated in kinship care. Compared to infants in the larger study, kinship babies received inadequate health care follow-up, including immunizations, and had more rehospitalizations but fewer acute care visits. Children in kinship care appear to have more health problems compared to American children in general. A system is required within our health care structure for maintaining accurate health records, delivering special care to these babies, and providing supportive services to the kinship caregivers.

Childbearing in Malawi, Africa

Malawi is a small, landlocked country in South Eastern Africa that faces many challenges in providing health care to childbearing women. Through a partnership between the faculty of the University of Pennsylvania, School of Nursing, faculty of the Kamuzu College of Nursing in Malawi, and the Malawi Ministry of Health and Population, an ongoing collaboration has led to research and demonstration projects designed to improve the health of women and children in Malawi. To underscore the cultural context within which childbearing occurs, care of the childbearing family in Malawi is described, as is research that has documented some of the similarities and differences between childbearing in Malawi and the United States.

Immune responses in mothers of term and preterm very-low-birth-weight infants

Differences in the levels of immune cell subsets present in peripheral blood have been demonstrated based on sociodemographic factors such as age and race. Postpartal women, who are recovering from the immune changes that are concomitant with pregnancy, have lymphocyte and monocyte values that differ from other populations. A subgroup of postpartal women, mothers who deliver preterm very-low-birth-weight (VLBW) (< or = 1,500 g) infants, may have further differences in values of immune cell subsets and in immune functioning either because of hormonal factors or lifestyle changes or because of the stress they experience after their infant's birth and for the first few months of infant caretaking. This study examined anxiety, depression, and immune cell phenotypes in 30 mothers of VLBW infants and in 30 mothers of healthy term infants over the first 4 postpartal months to determine if mothers of preterm VLBW infants differed from mothers of healthy term infants in psychological and immunologic parameters. Additionally, lymphocyte proliferation and natural killer cell functional assays were performed in a subset of mothers. Mothers of VLBW infants had increased anxiety and decreased lymphocyte proliferation compared to mothers of term infants. When lymphocyte and monocyte subsets were compared over time between the two groups of mothers differences were found in CD8, CD20, CD3-/CD56+, CD14, and HLA class II Ia on monocytes. Mothers with high-fat diets had lower percentages of some monocytes (CD14), lymphocytes (CD4+/CD45RA+), and natural killer cells (CD3-/CD57+) during the first 4 postpartal months.

Caregiving to very low birthweight infants: a model of stress and immune response

Mothers of preterm, very low birthweight (< or = 1500 g; VLBW) infants experience the stress of caring for small, fragile infants at the same time that they are recovering from the relative immunosuppression of pregnancy and when many health behaviour changes (e.g., nutrition) occur which also may influence immune status. The purpose of this study was to examine changes in anxiety and depression and in health behaviors, as well as lymphocyte proliferation and natural killer cell activity in mothers of preterm, VLBW infants compared to mothers of healthy term infants. Mothers of preterm VLBW infants have decreased in vitro lymphocyte response to mitogens compared to mothers of healthy term infants over time, and this difference could not be explained by anxiety, depression, or health behaviors. However, among mothers of VLBW infants, anxiety was related to decreased lymphocyte proliferation response at 1 month postpartum. There was no relationship between maternal depression and lymphocyte proliferative response in mothers of term infants. Natural killer cell activity did not differ between the two groups of mothers, nor was there a relationship between natural killer cell activity and maternal anxiety, depression, or health behaviors. Thus, lymphocyte proliferative response to mitogens may be an important biologic market of increased stress in mothers of VLBW infants in the first couple of months postpartum.

Lymphocyte, monocyte, and natural killer cell reference ranges in postpartal women

Normative values for immune-cell subsets in postpartal women, who are recovering from the relative immunosuppression of pregnancy, have not been established. Considerable differences in normative values for subsets of immune cells have been demonstrated based on sociodemographic factors, such as age and race. In order to make accurate clinical decisions about postpartal women, comparisons with normal reference ranges are necessary. Therefore, flow cytometric data for 51 healthy women at 4 months postpartum are presented and changes over the first 4 postpartal months are documented. The levels of some lymphocyte cell subsets, such as CD4+/CD45RA+ and Ia on lymphocytes, remained stable over time. The levels of other lymphocyte cell subsets, such as CD4+/CD29+, increased over the first 4 postpartal months, while those of other cell subsets, such as CD8 and CD11b, increased between delivery and 2 months postpartum and then dropped again by the fourth postpartal month. The levels of two natural killer cell subsets (CD3-/CD16+ and CD3-/CD57+) rose from delivery until 1 month postpartum and then plateaued. Comparisons were made with reference ranges of nonpostpartal groups provided in the literature and in a study of healthy women being conducted in the same laboratory, and postpartal women were found to have lower values of CD8, CD3-/CD16+, CD4+/CD45RA+, CD20, and CD11b than those reported in the literature.

Weight, nutrition, and immune status in postpartal women

Postpartal weight loss, nutritional intake, and immune status were examined in 65 women. Although 80% of the women lost weight and were not overweight by the 4th postpartal month, the majority had diets that were inadequate in fat content (> or = 30% of calories from fat) or protein content (< or = 12% of calories from protein), or in terms of caloric intake (< or = 1,200 calories or > or = 2,200 calories). Differences in some immune cell subsets were noted between women with high-fat and normal-fat diets. Women with high-fat diets had lower percentages of specific immune cell subsets than women with normal-fat diets. Protein intake was not related to immune cell phenotypes.

Leave and employment in families of preterm low birthweight infants

OBJECTIVE

To determine how employment, income and out-of-pocket expenses changed in 224 families of low birthweight infants during the first 6 months after the infant was discharged home.

DESIGN

Prospective, descriptive. POPULATION, SAMPLE, SETTING, YEARS: Families of preterm, low birthweight infants. A convenience sample of families of 224 preterm (< 37 weeks gestation) low birthweight (< 2500 grams) infants was obtained from one hospital in the Northeastern U.S.A. Mothers were interviewed over the telephone at each of the data points. Years of data collections were 1990-1994.

METHODS

Mothers kept logs of expenses and were interviewed about changes in employment and income at infant discharge from the hospital and 1, 3, and 6 months later.

FINDINGS

All but two of the employed mothers had to leave employment early because of pregnancy complications. After delivery, fewer mothers returned to work or returned later and worked less than mothers in national studies. Families spent 2% to 4% of their income in non-reimbursed out-of-pocket expenses; transportation was a major expense.

CONCLUSIONS

Having a low birthweight infant results in unexpected changes in employment and in increased and unexpected out-of-pocket expenses.

CLINICAL IMPLICATIONS

Study findings support the need for longer leave for mothers who have small infants.

The correlation of sucking behaviors and Bayley Scales of Infant Development at six months of age in VLBW infants

The purpose of this study was to identify early predictors of developmental outcomes in infants of very low birth weight (< or = 1,500 g). The sample consisted of 19 infants with a mean birth weight of 1,238 g and a mean gestational age at birth of 29.1 weeks. The instruments used were the Kron Nutritive Sucking Apparatus, the Neonatal Morbidity Scale, and the Bayley Scales of Infant Development (BSID). Mean pressure generated by each suck and the length of sucking bursts were positively correlated (p < .05) with the Psychomotor Scale of the BSID. As a predictor of developmental outcomes at 6 months of age, nutritive sucking demonstrated a 78% specificity and an 80% sensitivity, as compared with neonatal morbidity, 58% and 69%, respectively. In a small sample of relatively healthy preterm infants, their ability to suck helped identify those with questionable early development.

Stress, immune function, and relationship to pregnancy outcome

Pregnancy and the postpartal period are a time of immunosuppression. The normal immunosuppression that occurs during the puerperium may be aggravated by stress. Normal mechanisms of immunosuppression are discussed, and the research related to stress and childbearing is examined in this article.

Family response to the low birth weight infant

Families of VLBW and LBW preterm infants are usually happy to have a new baby in the family, although they are anxious, depressed, and concerned about their infant's future health and well-being. During the first year of the infant's life, families of LBW and VLBW infants face many new challenges. They have infants with unique health-care needs who are often temperamentally difficult and who benefit enormously from excellent parenting. Preterm LBW and VLBW infants are often born to families who are poor and to mothers who are young. Families of VLBW and LBW preterm infants experience decreased employment possibilities at a time when they also have increased expenses. Families of LBW and VLBW preterm infants undergo a vulnerable period during which they may benefit greatly from receiving care from nurses who understand their needs.

Patterns of postpartum health in mothers of low birth weight infants

Our purpose in conducting this prospective, descriptive study was to examine patterns of maternal health in women who delivered a low birth weight (LBW; < or = 2,500 g) infant until 6 months past the mothers' estimated date of confinement (EDC). Sixty-eight mothers of LBW infants were interviewed at nine data collection points: delivery, original EDC, infant discharge, and every month thereafter for 6 months. Health was assessed using the Health Perceptions Questionnaire and a structured interview (the Health Interview Schedule). Maternal acute care visits occurred throughout the study, with at least 71% of the mothers reporting one acute care visit. Sixty-four percent of the mothers reported having to change their activities because of ill health between the time their infant went home and the 6-month data point. At the 6-month data point, 19% of the mothers still rated their health as fair to very poor. An ongoing assessment of maternal health is important in mothers of LBW infants so that their health can be optimized.

High-risk obstetric nursing role: perinatal nurse practitioner

This article chronicles the development of the perinatal nurse practitioner (PNNP) role in providing care to high-risk obstetric patients in ambulatory and inpatient settings. Factors in the health care delivery system as well as the philosophic basis of the role are discussed. This role was modeled after neonatal nurse practitioners. Curriculum examples and role competencies are identified. Four programs are currently in existence with several more in the planning stages

Perinatal nurse practitioners and health care reform

Health care delivery for pregnant women at high risk is changing in response to the nation's need to contain costs and improve care. Perinatal nurse practitioners can provide specialized care to women at high risk in a wide variety of settings. They provide quality, cost-effective care and can improve access to prenatal care for families at risk for untoward pregnancy outcomes.

The perinatal evaluation center: a nurse practitioner service delivery model

Efforts to reduce overall health care costs, improve efficiency and enhance patient and provider satisfaction have stimulated the design and evaluation of new models of practice. The Perinatal Evaluation Center, a nurse practitioner-staffed service providing triage and evaluation for obstetrical patients, was developed to address the competing demands of health care redesign. The service has yielded improved outcomes in measures of efficiency and satisfaction.

A sociodemographic comparison of families of very low-birthweight infants: 1982-1991

Social and demographic characteristics were investigated in families who had very low birthweight infants between 1982 and 1984 (historical cohort). Since those data were collected, the number of women using drugs during pregnancy has increased significantly. Therefore, between 1989 and 1991 (current cohort) we continued to document sociodemographic characteristics of families of very low-birthweight infants (144 mothers, 156 infants). Data were collected from review of hospital charts and outpatient health records, and monthly interviews. The two cohorts were similar demographically. Changes in family composition occurred more frequently in the current cohort. There was a startling increase in illicit drug use between the two groups of women 3% in the historic cohort and 20% in the current cohort. In the historical cohort all infants went home to their mothers; however, in the current cohort 7.8% of infants were placed with other family caretakers. Infant health outcomes for the first six months after hospital discharge were similar in both groups. From 1982 to 1991 the increases in substance abuse, nonmaternal caretakers, family moves, and changes in family composition have implications for health care providers involved in infant follow-up care.

Research utilization: an overview

Nursing practice needs to be research based, not only to provide the best possible care to patients but also to ensure that nursing as a profession continues to grow. Criteria to help nurses determine how and when to implement research-based practice changes are presented. Forces that facilitate research utilization are discussed, as are barriers to research utilization. Areas of research that are ready to be implemented in women's health, obstetric, and neonatal nursing are presented.

The association between CNS direct care time and total time and very low birth weight infant outcomes

This study examined the association between the amount of direct care time and total time (direct and administrative) spent by CNSs with families of 39 very low birth weight infants (< or = 1500 grams) and infant outcomes (rehospitalizations and acute care visits). Documentation of the CNSs' time spent with infants and families was recorded during infant hospitalization and for 18 months after infant discharge. The number of infant rehospitalizations and acute care visits was recorded from hospital and physician records. The mean total time the CNS spent per infant for the 18-month period was 27.3 hours. After discharge, there were significant relationships between the amount of CNS direct care time and the number of acute care visits (r = 0.45, p < 0.01) and infant rehospitalizations (r = 0.51, p < 0.01). Although the study findings did not demonstrate improved infant outcomes associated with the amount of time the CNS spent with this high risk population, they document the amount of CNS time spent in intervention and follow-up of these infants. This study provides data for costing home visiting by the CNS in this patient population.

Health policy dilemmas related to high technology infertility services

As cost containment in health care becomes an important concern, the costs and benefits of specific health care services will be more closely examined. The costs and benefits of one type of health care, high technology infertility services, are explored in this paper. These services may be particularly susceptible to cost containment since they are costly, raise ethical issues, and because they currently are provided to healthy individuals not experiencing life-threatening illness who can afford them.