Nursing care: a phenomenological view of the leukemic patient

The present investigation approaches the nursing care process from the patient with leukemia perspective. The author departs from the feeling of uneasiness emerged in her quotidian either as a nurse practitioner and nursing professor and seeks to apprehend the sense of care within the everyday existence of the leukemic patient as a world-inserted human being. Also, the author presents reflexions on the path to be followed and finds an appropriate method to disclose the subjects veiled discourse based either in the phenomenological qualitative methodology and Heideggerian Hermeneutics; thus, the mode by which nursing care is perceived by the leukemic patient may be seen as a non-authentic from of being-with, have the nursing care delivered in a distinctive way, care given with patience and understanding, and receive that same type of care as an authentic form of being-with. By uncovering the sense emerged through those speeches, the investigator is likely to re-learn the care required to be provided in accordance with the studied subjects speech.     

Integrated maternal and infant health care in the postpartum period in a poor neighborhood in Santiago, Chile

An integrated postpartum health-care program was established by the Consultorio San Luis de Huechuraba (CSLH), a nongovernmental organization in a neighborhood of extreme poverty in Santiago, Chile. The main components were education, maternal and infant health care, support for the mothers, and active participation of women from the community served. The program was evaluated through indicators of contraceptive use, breastfeeding performance, infant growth and health, and a qualitative assessment of women's satisfaction. Controls were women of similar characteristics attending the nearby public clinic. Acceptability of contraceptive methods was similar but contraceptive options differed between clinics. The total number of pregnancies and of respondents lost to follow-up was significantly higher for the public clinic than for the CSLH. Breastfeeding duration was significantly longer and infant growth and health were found to be significantly better at the CSLH than at the public clinic. Women valued being treated with respect, receiving education and support, and being offered timesaving services and wider contraceptive choices at the CSLH. This study demonstrates that such interventions are possible for poor communities, providing significant advantages for women and children.     

Helicobacter pylori is not a determinant factor of persistent diarrhoea or malnutrition in Peruvian children

To investigate the role of Helicobacter pylori in childhood diarrhoea, specific IgG antibodies to H. pylori (determined by an ELISA) were sought in 119 infants aged 3-36 months in Peru. Thirty one of the infants had acute diarrhoea (defined as lasting < 72 h and not present in the previous 3 weeks), 67 had persistent diarrhoea (lasting > or = 14 days with no more than 1 intervening diarrhoea-free day) and the remaining 21 had not had diarrhoea in the previous 3 weeks. The children with diarrhoea had been admitted to hospital in Lima for diarrhoea treatment, and the diarrhoea-free children for investigation of possible tuberculosis. Aspirates of duodenal contents and duplicate stool samples were investigated for the presence of bacterial overgrowth and of pathogenic bacteria, viruses and parasites. Anthropometric measurements were also made. There were no statistically significant differences between the prevalence rates of IgG against H. pylori in the children with acute diarrhoea, persistent diarrhoea and without diarrhoea (32%, 43% and 29%, respectively). In addition, H. pylori infection (as evidenced by specific antibodies) had no apparent influence on the presence of small-bowel overgrowth (in 20% of seropositive children compared with 18% of seronegative children) or of pathogens in the stool (in 53% of seropositive children compared with 49% of seronegative children) or on the occurrence of malnutrition in the groups of children considered as a whole. We conclude that H. pylori infection is not associated with acute or persistent diarrhoeal disease, small-bowel overgrowth, stool pathogens or malnutrition in Peruvian children.     

Socioeconomic inequalities in mortality among women and among men: an international study

OBJECTIVES: This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia. METHODS: National data were obtained for the period ca. 1980 to ca. 1990. Age-adjusted rate ratios comparing a broad lower-educational group with a broad upper-educational group were calculated with Poisson regression analysis. RESULTS: Total mortality rate ratios among women ranged from 1.09 in the Czech Republic to 1.31 in the United States and Estonia. Higher mortality rates among lower-educated women were found for most causes of death, but not for neoplasms. Relative inequalities in total mortality tended to be smaller among women than among men. In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of-death pattern. For specific causes of death, inequalities are usually larger among men. CONCLUSIONS: Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health.     

Mortality among homeless shelter residents in New York City

OBJECTIVES: This study examined the rates and predictors of mortality among sheltered homeless men and women in New York City. METHODS: Identifying data on a representative sample of shelter residents surveyed in 1987 were matched against national mortality records for 1987 through 1994. Standardized mortality ratios were computed to compare death rates among homeless people with those of the general US and New York City populations. Logistic regression analysis was used to examine predictors of mortality within the homeless sample. RESULTS: Age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City. Among homeless men, prior use of injectable drugs, incarceration, and chronic homelessness increased the likelihood of death. CONCLUSIONS: For homeless shelter users, chronic homelessness itself compounds the high risk of death associated with disease/disability and intravenous drug use. Interventions must address not only the health conditions of the homeless but also the societal conditions that perpetuate homelessness.     

Structure of Peroxisomes and Activity of the Marker Enzyme Catalase in Digestive Epithelial Cells in Relation to PAH Content of Mussels from Two Basque Estuaries (Bay of Biscay): Seasonal and Site-Specific Variations

The aim of the present work was to study the seasonal as well as the site-specific variations in the structure of peroxisomes and in the activity of the peroxisomal marker enzyme catalase in digestive epithelial cells of mussels to validate the potential use of these parameters as early biomarkers of environmental organic pollution in estuarine ecosystems. For this purpose, mussels were sampled monthly for 14 months in two Basque estuaries (Bay of Biscay) with different degrees of pollution. Stereological procedures were applied to detect changes in peroxisome structure, and microspectrophotometry was used to quantify changes in catalase activity. The animals from the two studied sampling sites presented differences in polycyclic aromatic hydrocarbon (PAH) burdens, mussels from Plentzia generally showing lower total PAH contents than mussels from Galea. The peroxisome structure of the animals from the two estuaries suffered seasonal variations that were of different kind and intensity in both sites. In this way, a strong peroxisome proliferatory response was found in mussels sampled in Plentzia during the summer months, while mussels from Galea presented few variations along the year. Catalase activity behaved similarly in the animals sampled in the two estuaries, with higher values in spring. It appeared that mussels exposed chronically to PAHs and other pollutants, such as those from Galea, lost their ability to respond to this exposure in terms of peroxisome proliferation. In contrast, mussels collected in Plentzia effectively responded to an increased bioavailability of organic pollutants during the summer by increasing peroxisome volume and surface and numerical densities in digestive epithelial cells. However, these increases were transient because elevated PAH body burdens detected in mussels sampled in Plentzia in autumn were not accompanied by a peroxisome proliferatory response. Further studies are needed before changes in peroxisomal structure and in the activity of catalase could be used as early biomarkers to assess environmental quality in pollution monitoring programs like the Mussel Watch. Received: 8 March 1998/Accepted: 30 September 1998     

The adverse effect of low levels of ambient air pollutants on lung function growth in preadolescent children.

The main purpose of our study was to assess the effect of low concentrations of ambient air pollution on lung function growth in preadolescent children. We accounted for height velocity over the follow-up period and also for other possible confounders such as baseline anthropometric and physiologic characteristics of children. In addition to outdoor air pollution, we considered the possible effects of social class and exposure to indoor pollutants such as gas stove fumes or environmental tobacco smoke. The cohort prospective study was carried out in 1,001 preadolescent children from two areas of Krakow, Poland, that differed in ambient air pollutants. In the city center (higher pollution area), the mean annual level [+/- standard deviation (SD)] of suspended particulate matter was 52.6 +/- 53.98 microg/m(3) and that of SO(2) was 43.87 +/- 32.69 microg/m(3); the corresponding values in the control area were 33.23 +/- 35.99 microg/m(3) and 31.77 +/- 21.93 microg/m(3). Mean lung function growth rate adjusted to height velocity and lung function level at the study entry was significantly lower in boys and girls living in the more polluted areas. Also, the proportion of children with the slower lung function growth (SLFG) was higher in the children from the more polluted area of the city. The analysis completed in the group of children after the exclusion of asthmatic subjects and those with asthmalike symptoms confirmed that, in boys, odds ratios (ORs) for SLFG [forced vital capacity (FVC)] and air pollution after adjustment to baseline FVC, height, and growth rate was significant [OR = 2.15; 95% confidence interval (CI), 1.25-3. 69)]. The analysis also confirmed that for SLFG(FEV(1)) the OR was 1. 90 (CI, 1.12-3.25). The corresponding OR values in girls were insignificant (OR = 1.50; CI, 0.84-2.68 and OR = 1.39; CI, 0.78-2. 44). The association between ambient pollutants and poorer gain of pulmonary volumes in children living in more polluted areas suggests that air pollution in the residence area may be a part of the causal chain of reactions leading to retardation in pulmonary function growth during the preadolescent years.     

Insulin-like growth factor-I, but not growth hormone, is dependent on a high protein intake to increase nitrogen balance in the rat.

The aim of the present study was to investigate the influence of dietary protein level on the protein anabolic effects of growth hormone (GH) and insulin-like growth factor-I (IGF-I). Female growing rats were fed on either a high- or a low-protein diet with crude protein contents of 222 and 83 g/kg respectively. The diets contained the same amount of metabolizable energy (15.1 MJ/kg) and were given during a 14 d period. During the same time, three groups of rats (n 8) on each diet received subcutaneous infusions of either saline, recombinant human GH (rhGH) or recombinant human IGF-I (rhIGF-I). rhGH and rhIGF-I were given in doses of 360 and 500 micrograms/d respectively. The low-protein diet alone reduced significantly (P < 0.05) IGF-I concentrations in serum and in tissue taken from the gastrocnemius muscle as well as IGF-I mRNA from the same muscle. The responses to rhGH and rhIGF-I in terms of muscle IGF-I and its mRNA were variable. However, when rhIGF-I was infused into rats on the high-protein diet, significantly elevated levels of IGF-I in muscle tissues could be observed. This was associated with a significantly (P < 0.05) increased N balance, whereas rhGH significantly (P < 0.05) enhanced the N balance in rats on the low-protein diet. Thus, it can be concluded that the level of dietary protein ingested regulates not only the effect of IGF-I on whole-body N economy but also the regulation of IGF-I gene expression in muscles. The exact mechanism by which GH exerts its protein anabolic effect, however, remains to be elucidated.     

Olive oil- and fish oil-enriched diets modify plasma lipids and susceptibility of LDL to oxidative modification in free-living male patients with peripheral vascular disease: the Spanish Nutrition Study

The present study describes a clinical trial in which Spanish patients suffering from peripheral vascular disease (Fontaine stage II) were given specific lipid supplements. Designed as a longitudinal intervention study, patients were provided with olive oil for 3 months, followed by a 3 month wash-out period, then supplemented with a combination of fish oil and olive oil for the final 3 months. Changes in plasma and lipoprotein fatty acid composition and susceptibility of LDL to in vitro oxidation were examined. Furthermore, lipid-supplement-induced changes in LDL properties were measured as relative electrophoretic mobility and macrophage uptake. In addition, thirteen patients not provided with olive oil and fish oil were included as a control group and twenty healthy age-matched individuals were used as a reference group. A complete clinical study and a nutritional survey concerning food habits and lifestyle were performed every 3 months. Yao indices and claudicometry did not change significantly with dietary intervention although changes in plasma lipid composition suggested an improvement in the condition of the patients. The intake of the fish-oil supplement resulted in significantly increased plasma levels of eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3) in comparison with baseline concentrations, olive-oil and control groups. Fish-oil consumption significantly decreased plasma triacylglycerol levels compared with the olive-oil period, control and reference groups. The susceptibility of LDL to Cu-mediated oxidation was lower in the patients consuming olive oil and the fish-oil supplement than in the control group, and the uptake of LDL by macrophages was significantly lower in the group supplemented with fish oil. In conclusion, consumption of olive oil together with a dietary supplement of fish oil may be useful in the nutritional management of patients suffering from peripheral vascular disease in terms of increasing plasma n-3 long-chain polyunsaturated fatty acids and decreasing susceptibility of LDL to oxidation.     

High dietary folate supplementation affects gestational development and dietary protein utilization in rats.

There is new evidence that good folate status may play a critical role in the prevention of neural tube defects and in the maintenance of adequate homocysteine levels, an amino acid recently identified as a risk factor for cardiovascular disease. This has led to different folate recommendations, all of them much higher than the present dietary recommendations. Folic acid is a water-soluble vitamin with a low potential toxicity. However, the possible consequences of long-term, high folate intakes are unknown. Therefore, the present study was undertaken to determine the effects of long-term, high dietary folate supplementation on gestational and nutritional markers in pregnant and virgin rats. Four groups of Wistar rats were classified on the basis of physiological status (virgin or pregnant) and the experimental diets administered (folic acid supplemented, 40 mg/kg diet; or control diet, 2 mg folic acid/kg diet). Rats were fed their respective diets for 3 wk. Two critical periods were used for metabolic balance studies (experimental d 1-5 and 17-21), which involved the determination of fat and protein digestibilities as well as metabolic protein utilization (MPU) and net protein utilization (NPU). Gestational development (number of live fetuses) was adequate in both diet groups regardless of folate supplementation. However, body weight and vertex-coccyx length in fetuses from supplemented dams were less than (P < 0.0001) in fetuses of control dams. Fat and nitrogen digestibilities were not affected by supplementation, but MPU and NPU coefficients were significantly lower (P < 0.05) in the folic acid-supplemented groups, irrespective of physiological status, compared to control rats. These new findings of macro-micronutrient interactions caused by high folate supplementation are discussed on the basis that the vitamin may act as a xenobiotic more than as a nutrient.