Herbal remedies as a potential cause of hypoadrenalism.

A 37-year-old woman presented with nausea, vomiting and headache. She was found to be profoundly hyponatraemic with a sodium of 121 mmol/L, which deteriorated following a fluid challenge. An initial hyponatraemia screen identified adrenal insufficiency, with cortisol of 48 nmol/L. History confirmed she had been taking the herbal plant, ashwagandha. After 3 days of fluid restriction and steroid replacement, her sodium returned to normal (139 mmol/L). This article reviews the possible harmful effects of over-the-counter herbal remedies and highlights the importance of considering a wide differential diagnosis in patients presenting with non-specific symptoms.

The Use of Facilities for Labor and Delivery: The Views of Women in Rural Uganda.

The aim of the paper is to explore factors associated with home or hospital delivery in rural Uganda. Qualitative interviews with recently-delivered women in rural Uganda and statistical analysis of data from the 2011 Ugandan Demographic and Health Survey (DHS) to assess the association between socio-demographic and cultural factors and delivery location in multivariable regression models. In the DHS, 61.7% (of 4907) women had a facility-based delivery (FBD); in adjusted analyses, FBD was associated with an urban setting [adjusted odds ratio (aOR) 3.38, 95% confidence interval (CI) 2.66 to 4.28)], the upper wealth quintile (aOR: 3.69, 95%CI 2.79 to 3.87) and with secondary education (aOR: 3.07, 95%CI 2.37 to 3.96). In interviews women quoted costs and distance as barriers to FBD. Other factors reported in interviews to be associated with FBD included family influence, perceived necessity of care (weak women needed FBD), and the reputation of the facility (women bypassed local facilities to deliver at better hospitals). Choosing a FBD is a complex decision and education around the benefits of FBD should be combined with interventions designed to remove barriers to FBD.

Stress among caregivers of chronically ill older adults: implications for nursing practice.

Caregiving is a dynamic process involving a series of decisions at different stages of a person's chronic illness trajectory. Research suggests the burdens of caregiving can lead to caregiver stress, the actual or perceived physical or emotional strain experienced by the caregiver. Nurses have a pivotal role in assessing for caregiver stress and providing interventions to assist caregivers. This article defines caregiver stress, discusses the impact that caregiving has on a caregiver, provides assessment principles to identify caregiver stress, and includes evidence-based interventions that can be tailored to individual caregivers to encourage health-promoting behaviors.

A cross country review of the validation and/or adjustment of census data.

This article reviews existing procedures employed by various countries in the evaluation of, and/or adjustment, either of census data, or of population estimates based upon census data. The work was carried out to ensure all potential demographic techniques are considered by the ONS for the post census evaluation process of the 2011 Census.