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1.
J Comp Neurol ; 519(1): 21-33, 2011 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-21120925

RESUMO

Poor functional recovery found after peripheral nerve injury has been attributed to the misdirection of regenerating axons to reinnervate functionally inappropriate muscles. We applied brief electrical stimulation (ES) to the common fibular (CF) but not the tibial (Tib) nerve just prior to transection and repair of the entire rat sciatic nerve, to attempt to influence the misdirection of its regenerating axons. The specificity with which regenerating axons reinnervated appropriate targets was evaluated physiologically using compound muscle action potentials (M responses) evoked from stimulation of the two nerve branches above the injury site. Functional recovery was assayed using the timing of electromyography (EMG) activity recorded from the tibialis anterior (TA) and soleus (Sol) muscles during treadmill locomotion and kinematic analysis of hindlimb locomotor movements. Selective ES of the CF nerve resulted in restored M-responses at earlier times than in unstimulated controls in both TA and Sol muscles. Stimulated CF axons reinnervated inappropriate targets to a greater extent than unstimulated Tib axons. During locomotion, functional antagonist muscles, TA and Sol, were coactivated both in stimulated rats and in unstimulated but injured rats. Hindlimb kinematics in stimulated rats were comparable to untreated rats, but significantly different from intact controls. Selective ES promotes enhanced axon regeneration but does so with decreased fidelity of muscle reinnervation. Functional recovery is neither improved nor degraded, suggesting that compensatory changes in the outputs of the spinal circuits driving locomotion may occur irrespective of the extent of misdirection of regenerating axons in the periphery.


Assuntos
Axônios/fisiologia , Terapia por Estimulação Elétrica , Regeneração Nervosa/fisiologia , Recuperação de Função Fisiológica/fisiologia , Nervo Isquiático/lesões , Animais , Axotomia , Eletromiografia , Potencial Evocado Motor , Feminino , Músculos/inervação , Ratos , Ratos Sprague-Dawley , Nervo Isquiático/fisiologia
2.
Midwifery ; 26(3): e1-e13, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18692285

RESUMO

OBJECTIVE: to develop a pragmatic service for pregnant smokers. DESIGN: identification and referral of pregnant smokers to specialist services using self-report gathered on routine pregnancy booking questionnaire augmented by a carbon monoxide breath test. Engagement by specialist smoking cessation midwives using telephone contact with the offer of clinic-based counselling for women who want help. Telephone support and pharmacy provision of nicotine replacement therapy for women who decide to quit. SETTING: three maternity units serving Glasgow in the West of Scotland. PARTICIPANTS: a relatively deprived population of 12,000 pregnant women each year in Glasgow. INTERVENTIONS: at maternity booking, women with either a carbon monoxide breath test result >7 parts per million or self-reporting to be a current smoker during the routine pregnancy booking questionnaire were identified as smokers. All smokers were referred on to the specially trained midwives who provided an opt-out smoking cessation intervention. This involved motivational interviewing to engage pregnant smokers during telephone contact. Women considering quitting were invited for a follow-up face-to-face meeting in a clinic setting. Women who set a quit date were offered withdrawal oriented therapy augmented by pharmacy-based nicotine replacement therapy. FINDINGS: booking midwives found it difficult to approach all pregnant women to talk about smoking. This was not made easier by the service requirement that all pregnant women should provide a carbon monoxide breath test at maternity booking. In one hospital, auxiliary nurses performed the carbon monoxide breath test and 2879 of 3219 (89%) women booking for antenatal care provided a sample, allowing most smokers to be identified. In another hospital where the carbon monoxide test was administered by midwives, only 1968 of 5570 (35%) women provided a carbon monoxide breath test sample; 61% of pregnant smokers were not identified and referred to specialist services. Of the 1936 pregnant smokers referred from all three hospitals, 386 (20%) attended a face-to-face appointment with specialist smoking cessation midwives, 370 (19%) set a quit date and 117 (6%) had quit 4 weeks after their quit date. IMPLICATIONS FOR PRACTICE: this service development provides a pragmatic approach to identify nearly all pregnant smokers at maternity booking, and an opt-out model to refer them to specialist smoking cessation services. Further research is required to establish if extra auxiliary staff in maternity booking clinics can optimise the identification and referral of pregnant smokers to specialist smoking cessation services. This telephone- and clinic-based specialist service engaged 20% of referred pregnant smokers to attend a face-to-face appointment with a specialist smoking cessation midwife. Further research is required to assess if home-based support would engage a greater proportion of pregnant smokers, or if an incentive scheme would achieve the same aim. In total, 117 of 370 (32%) women who set a quit date had quit smoking 4 weeks later, which compares fairly well with a figure of 40% for pregnant smokers in the English smoking treatment services.


Assuntos
Enfermeiros Obstétricos/organização & administração , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/organização & administração , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Testes Respiratórios , Monóxido de Carbono/análise , Aconselhamento/organização & administração , Feminino , Estimulantes Ganglionares/uso terapêutico , Humanos , Nicotina/uso terapêutico , Pesquisa em Avaliação de Enfermagem , Educação de Pacientes como Assunto/organização & administração , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta , Escócia/epidemiologia , Fumar/epidemiologia , Apoio Social , Telefone
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