Substance use in pregnancy: do we care?

Two cohorts of substance-using women were compared retrospectively. From 1969 to 1979 a very high perinatal mortality rate (PMR 9.8%) was found among 92 polydrug-using women (1 twin excluded). Preterm delivery occurred in 25% of all pregnancies and in 30% of the children birth weight was below the 10th percentile. Nineteen women using heroin only had a worse fetal outcome (PMR 32%, preterm delivery in 47%, birth weight < 10th percentile in 42%). These results led to a strict surveillance system. In the period 1980–1989, 240 women (4 twins excluded) delivered after 16 weeks. Total fetal loss decreased to 2.1% and PMR to 0.4%, which was similar to results in controls. However, 22% of the women still delivered before 37 weeks and 27% delivered a child < 10th percentile. Methadone-using women were able to halve their dosage during pregnancy and 16 were detoxified. Multivariate analysis within the substance users of the second cohort showed that the neonatal abstinence syndrome, but not the (registered) amount of opiates used, was related to a lower birth weight. Not coping with prenatal care was related to a shorter pregnancy length. Multivariate analysis, including the controls, showed a significant relation of birth weight (345 g lower) with substance use. Also, head circumference was 0.8 cm smaller. Length of pregnancy however was related to smoking. This study shows that it is difficult to make substance users attend prenatal care, but also that women coping with prenatal care reduce substance intake. Opiate use might be responsible for lower birth weight, although not in a clear dose–response relationship, whereas lifestyle, as represented by not coping with prenatal care and the quantity of cigarette smoking, shortens the length of pregnancy.     

Effect of antimicrobial agents on the Euglena method of serum vitamin B12 assay

Antimicrobial agents in the serum may affect the results of the Euglena method of serum vitamin B(12) assay. Sulphonamides suppress the growth of Euglena in concentrations attainable in the serum during treatment; streptomycin, chlortetracycline, erythromycin, kanamycin, and nitrofurantoin bleach Euglena but only when present in concentrations far exceeding the normal peak therapeutic blood levels. False low results of serum vitamin B(12) assay due to inhibitory and/or bleaching substances in the serum can be readily detected by microscopy of the assay cultures and Euglena cell counts.     

Despairing women and healing outcomes: a unitary appreciative nursing perspective

The purpose of this article is to explicate unitary appreciative nursing and the emergence of healing outcomes associated with despairing women. Unitary appreciative nursing was derived from the science of unitary human beings, informed by the participatory worldview of cooperative inquiry, and shaped by the voices and perspectives of despairing women. It integrates 3 strands of responsiveness (unitary, appreciative, and participatory) to the chosen focus of practice. Healing outcomes for despairing women reflect a conceptualization of healing that involves realizing, knowing, and appreciating the wholeness of life, clarifying understandings of life patterning, and elucidating potentials and opportunities for the betterment of life-a journey toward human flourishing.     

Cigarette Smoking Among Lesbians, Gays, and Bisexuals: How Serious a Problem? (United States)

INTRODUCTION: Population-based health surveys seldom assess sexual orientation, which results in the absence of a reliable measure of smoking among lesbians, gays, and bisexuals (LGB), a population perceived to have higher risks of tobacco-related diseases. This is the first study to compare the cigarette smoking rate of LGB with that of heterosexual individuals using a population-based sample with both male and female adults, and to identify which sub segments of LGB population are particularly burdened by tobacco use. METHODS: California Health Interview Survey (CHIS), a population-based telephone survey was used to assess smoking prevalence and its correlates among respondents. Of 44,606 respondents, 343 self-identified as lesbian; 593 self-identified as gay; and 793 identified themselves as bisexual (511 female and 282 male). Statistical analysis was performed using SAS and SUDAAN. RESULTS: Lesbians' smoking rate (25.3%), was about 70% higher than that of heterosexual women (14.9%) Gay men had a smoking prevalence of 33.2%, comparing to heterosexual men (21.3%). After controlling for demographic variables, logistic regression analysis showed that lesbians and bisexual women were significantly more likely to smoke compared with heterosexual women (OR = 1.95 and OR = 2.08, respectively). Gay men were also significantly more likely to smoke than heterosexual men (OR = 2.13; 95% CI = 1.66-2.73). Being 35-44-years-old, non-Hispanic White, and having low-education attainment and low-household income were common demographic predictors of cigarette smoking among LGB. CONCLUSION: Our study provides the strongest evidence to date that lesbians, bisexual females, and gay men had significantly higher cigarette smoking prevalence rates than their heterosexual counterparts.     

Effect of verbal instructions on muscle activity and risk of injury to the anterior cruciate ligament during landing

BACKGROUND: Minimising the likelihood of injury to the anterior cruciate ligament (ACL) during abrupt deceleration requires proper synchrony of the quadriceps and hamstring muscles. However, it is not known whether simple verbal instructions can alter landing muscle activity to protect the knee. OBJECTIVE: To assess the efficacy of verbal instructions to alter landing muscle activity. METHODS: Twenty four athletes landed abruptly in single limb stance. Sagittal plane motion was recorded with an optoelectric device, and ground reaction force and surface electromyographic data were recorded for the rectus femoris, vastus lateralis, biceps femoris, and semimembranosus muscles. Subjects performed 10 landings per condition: normal landing (N); repeat normal landing (R); landing after instruction to increase knee flexion (K); and landing after instruction to recruit hamstring muscles earlier (M). Muscle bursts immediately before landing were analysed relative to initial foot-ground contact (IC). RESULTS: The K condition resulted in significantly (p相似文献   

添加谷氨酰胺的全胃肠外营养对造血干细胞移植术后常见并发症的防治作用

目的:严重的黏膜损伤是诱发造血干细胞移植后出现并发症的一常见原因,已有证据显示谷氨酰胺能降低接受化疗患儿黏膜炎的发生率。观察谷氨酰胺对异基因外周造血干细胞移植患者并发症及恢复的影响。方法:选择于2002-03/2006-11在河南省血液病研究所接受同胞异基因外周造血干细胞移植的48例血液系统肿瘤患者。所有患者及其家属对治疗和实验均知情同意,并经医院伦理委员会批准。所有患者移植前均处于完全缓解状态,营养中等或良好,心、肝、肾功能正常,将48例患者随机分为标准化全胃肠外营养液组(标准组,n=13)和加用谷氨酰胺的全胃肠外营养液组(谷氨酰胺组,n=35)。待患者中性粒细胞升至1.0×109L-1,且无任何感染指征,进行异基因外周造血干细胞移植。造血干细胞输注后第1天开始给予全胃肠外营养与胃肠外营养联合谷氨酰胺双肽,至中性粒细胞≥1.0×109L-1,且无消化道症状时停用。观察两组患者中性粒细胞恢复时间、出层流室时间以及关于感染、急性移植物抗宿主病等情况有无差异。结果:48例患者均进入结果分析。两组患者营养物质的摄入基本相同,谷氨酰胺组有6例发生黏膜炎,标准组有11例,差异显著(P<0.05);谷氨酰胺组有1例发生严重腹泻,标准组有5例,差异显著(P<0.05);谷氨酰胺组有3例发生临床感染,标准组有7例,差异显著(P<0.05);标准组中性粒细胞≥0.5×109L-1的持续时间短于谷氨酰胺组(P>0.05);谷氨酰胺组抗生素治疗时间及无菌病房居住时间较标准组短(P<0.05);两组急性移植物抗宿主病发生率差异无统计学意义(P>0.05)。结论:添加谷氨酰胺的全胃肠外营养可改善异基因造血干细胞移植患者的营养状态,减少感染及肠损害,减少急性移植物抗宿主病的发生,有利于异基因移植患者恢复。