The hospital-based adoption process: a primer for perinatal nurses

Although the number of women who relinquish their infants is declining, it is estimated that over 52,000 young women pursue an adoption plan every year. Perinatal nurses practicing in any facet of perinatal care may provide care for a woman implementing an adoption plan for her infant. The provision of care may include interaction with the birthfather, prospective adoptive parents, hospital social worker, and adoption agency or adoption attorney as part of the hospital-based adoption experience. Understanding infant adoption, including the history of adoption in the United States, birthfathers' rights, and knowledge of adoption resources provides nurses with essential information that will allow them to provide appropriate, sensitive, nonjudgmental care to all persons involved in the adoption process.     

Preserved vision without growth retardation after laparoscopic Roux-en-Y gastric bypass in a morbidly obese child with pseudotumor cerebri: 36-month follow-up

A 12-year-old boy presented with a weight of 136 kg and a history of progressive vision loss associated with unremitting pseudotumor cerebri requiring bilateral optic nerve sheath decompression. He underwent laparoscopic Roux-en-Y gastric bypass (RYGBP) without complication. At 36 months post-RYGBP, he has grown 5 cm since the time of surgery, his weight is 6.8 kg above his postoperative nadir weight of 68.2 kg, and his visual acuity has improved with OD 20/100 (preoperative, 20/200) and OS 20/70 (preoperative, 20/100). This case suggests that RYGBP can be performed safely and without stopping linear growth in carefully selected children.     

Effect of N-acetylcysteine on renal function in patients with chronic kidney disease

BACKGROUND: N-acetylcysteine (NAC) is commonly administered to high-risk individuals to attenuate the risk of contrast-induced nephropathy in spite of the debate regarding its efficacy. In several studies serum creatinine decreased after exposure to NAC and contrast dye. The mechanism by which NAC attenuates the decline in renal function is not known. Studies in subjects with normal renal function suggest NAC may have an effect on tubular secretion. AIM: The aim of this study was to determine the effect of NAC on renal function, measured by serum creatinine and Cystatin C, in patients with stage 3 chronic kidney disease. METHOD: Serum creatinine and Cystatin C were measured prior to, 4, 24 and 48 h after the administration of 600 mg oral NAC in 30 patients. The protocol was repeated with the addition of 1200 mg oral cimetidine administered 3 h before NAC. RESULTs: Serum creatinine was not significantly different from baseline (186 +/- 65 micromol/L) to 4 h (185 +/- 62 micromol/L), 24 h (187 +/- 64 micromol/L) or 48 h (184 +/- 61 micromol/L) post NAC, nor were Cystatin C levels. Co-administration of cimetidine resulted in a significant rise in serum creatinine with no change in Cystatin C levels. CONCLUSION: This study failed to detect a change in serum creatinine or Cystatin C after a single dose of NAC in participants with stage 3 chronic kidney disease. Further randomized trials of multiple doses and longer follow up are needed to confirm these results.     

The effects of hormone replacement therapy and resistance training on spine bone mineral density in early postmenopausal women

This study evaluated the additive effects of hormone replacement therapy (HRT) and a 1-year site-specific resistance-training (RT) program involving two free weight exercises (i.e., squat and deadlift) 2 days/week as a strategy to reverse or attenuate bone loss at the lumbar spine in early postmenopausal women. Participants from a group of self-selected HRT or non-HRT (N=141) users were randomly assigned to RT (exercise) or no training, creating four groups: 1) non-HRT plus RT [NHRT plus exercise (n=35)]; 2) HRT plus RT [HRT plus exercise (n=37)]; 3) HRT no resistance training [HRT no exercise (n=35)]; or 4) control [non-HRT no resistance training group (n=34)]. Mean age and months past menopause did not differ between groups (52.1+/-3.0 years and 52.8+/-9.9 months, respectively). Post-menopausal status was confirmed by follicle-stimulating hormone levels > or =40 mIU/mL. Bone mineral density (BMD) of the spine was assessed by Dual Energy X-ray Absorptiometry (Hologic), at baseline and month 12. Data were analyzed using a 4 (experimental condition) x 2 (time) repeated measures multivariate analysis of variance to determine the effects of RT on HRT and non-HRT in early postmenopausal women. The main effects for group (P<0.007), time (P<0.001), and the group by time interaction (P<0.001) were each significant. Control participants experienced an average of -3.6% reduction of BMD at the spine. HRT treatment with no exercise showed bone loss of -0.66%. One year of RT produced increases in spine BMD of +0.43% and +0.70%, respectively for the NHRT plus exercise, and HRT plus exercise groups with no differences between the NHRT and HRT exercise groups. In conclusion, RT alone was as effective as HRT in preventing bone loss at the spine and was more effective than HRT alone in attenuating bone loss at the spine. Moreover, there was no additional benefit in combining HRT with RT for preventing bone loss at the spine in this group of early postmenopausal women.     

Review of rural and regional alcohol research in Australia

Introduction: Alcohol is the most commonly used drug within Australia. Recently, there have been indications that there is a greater incidence of high‐risk drinking within rural populations as compared with their urban counterparts. High‐risk drinking is associated with numerous conditions, such as diabetes, heart attack and cancer, as well as acute harms such as assault, suicide and road accidents. The objective of this article is to review the current research and relevant data pertaining to alcohol use and alcohol‐related harms within rural Australia. Methods: This paper is a systematic review of 16 databases, including PubMed, PsycINFO and Google Scholar. Results: Overall, 18 studies describing alcohol consumption or alcohol‐related harms were found. Approximately half of these studies were large‐scale national population surveys, which were therefore limited in their representativeness of specific regional and rural towns. Most studies examining alcohol consumption used self‐report data collection, meaning that interpretation of results needs to be tentative. There is a consistent pattern of higher rates of alcohol consumption and consequent harm within regional and rural Australia than in urban areas. Conclusions: There is emerging research examining alcohol consumption and alcohol‐related harms within regional and rural Australia. All studies show that these populations experience disproportionate harm because of alcohol consumption. The causes and mechanism for this have not been investigated, and a program of research is required to understand how and why rural populations experience disproportionate levels of alcohol‐related harm and ultimately, what interventions will be most effective in reducing alcohol‐related harms.     

How Mothers Respond to Their Crying Infant

INTRODUCTION: The purpose of this study was to allow mothers who are at high risk for abusing their child to describe how they manage when their infant cries. METHOD: This phenomenologic qualitative study used a focus group design and semi-structured interview format. Participants were seven low-income women with a child enrolled in an urban day care facility, which provided the setting for data collection. RESULTS: Analyses of the data revealed three themes: (a) activities done to pacify the infant, (b) coping mechanism, and (c) social support available. DISCUSSION: The results of this study indicate that activities (a) may include the infant, such as holding and singing, or (b) may be directed toward the mother, such as using headphones or leaving the room. These activities follow the guidelines of the American Academy of Pediatrics and are not unique. Social support primarily was provided at the day care facility, supplemented with personal relationships that are tentative. Valued informal and formal interactions with supportive persons provide the emotional and psychosocial support for this at-risk population.