A framework for One Health research.

The need for multidisciplinary research to address today's complex health and environmental challenges has never been greater. The One Health (OH) approach to research ensures that human, animal, and environmental health questions are evaluated in an integrated and holistic manner to provide a more comprehensive understanding of the problem and potential solutions than would be possible with siloed approaches. However, the OH approach is complex, and there is limited guidance available for investigators regarding the practical design and implementation of OH research. In this paper we provide a framework to guide researchers through conceptualizing and planning an OH study. We discuss key steps in designing an OH study, including conceptualization of hypotheses and study aims, identification of collaborators for a multi-disciplinary research team, study design options, data sources and collection methods, and analytical methods. We illustrate these concepts through the presentation of a case study of health impacts associated with land application of biosolids. Finally, we discuss opportunities for applying an OH approach to identify solutions to current global health issues, and the need for cross-disciplinary funding sources to foster an OH approach to research.

Atopic dermatitis complicated by eczema herpeticum is associated with HLA B7 and reduced interferon-γ-producing CD8+ T cells.

BACKGROUND: The increased susceptibility of patients with atopic dermatitis (AD) to disseminated viral skin infections such as eczema herpeticum (ADEH+) is poorly understood. OBJECTIVES: The primary goal of the current study was to determine whether ADEH+ subjects have identifiable defects in cell-mediated immunity that reduce their ability to control viral infections. MATERIALS AND METHODS: In this study, we evaluated cytokine expression by various subsets of peripheral blood mononuclear cells from ADEH+ (n = 24) compared with AD without a history of viral infections (ADEH-) (n = 20) before and after treatment with herpes simplex virus (HSV). RESULTS: We found that interferon (IFN)-γ expression after HSV treatment was lower in the CD8+ T cells and monocytes from patients with ADEH+ compared with patients who are ADEH- or nonatopic. Given the induction of CD8+ T cells as the result of antigen presentation by human leucocyte antigen (HLA) class I, consistent with the findings described above we also found that the HLA B7 allele was significantly associated with risk of the ADEH+ phenotype (odds ratio = 1·91, P = 0·02, 125 ADEH+ and 161 ADEH- subjects). CONCLUSIONS: These data suggest that defects in viral-induced IFN-γ from CD8+ T cells contribute to the ADEH+ phenotype.

Atopic dermo-respiratory syndrome is a correlate of eczema herpeticum.

BACKGROUND: Factors favoring the emergence of eczema herpeticum (EH) in patients with atopic dermatitis (AD) remain elusive. The aim of this work was to identify changes in clinical and laboratory parameters in acute EH patients, before and after 6 weeks of treatment, as well as differences between AD patients with and without a history of EH. METHODS: A total of 235 adult subjects were included and subdivided into six groups: (i) AD patients with acute EH, (ii) AD patients with history of EH, (iii) AD without EH but with recurrent herpes simplex virus (HSV) infections, (iv) AD without EH or recurrent HSV infections and healthy non-AD controls (v) with and (vi) without recurrent HSV infections. Clinical examination of AD, assessment of atopic status and severity were performed. Total IgE, allergen-specific IgE and differential blood count were analyzed. Clinical diagnosis of acute EH was confirmed by PCR. RESULTS: More male patients with AD were affected by EH than female patients. Acute episodes of EH are characterized by lower levels of lymphocytes and higher levels of monocytes. AD patients with history of EH display higher total IgE serum levels (ADEH(+) HSV(+) vs ADEH(-) HSV(+) , P < 0.001) and higher sensitization profiles and stronger severity of AD (EASI and SCORAD; ADEH(+) HSV(+) vs ADEH(-) HSV(+) , P < 0.001). Concomitant asthma and rhinitis were identified as correlates of EH. CONCLUSION: From these data, we conclude that AD patients with EH display a distinct clinical and biological phenotype.

Caloric restriction lowers plasma lipoprotein (a) in male but not female rhesus monkeys.

Many age-associated pathophysiological changes are retarded by caloric restriction (CR). The present study has investigated the effect of CR on plasma lipoprotein (a) [Lp(a)], an independent risk factor for the age-associated process of atherosclerosis. Rhesus monkeys were fed a control diet (n=19 males, 12 females) or subjected to CR (n=20 males, 11 females fed 30% less calories) for >2 years. All female animals were premenopausal. Plasma Lp(a) levels in control animals were almost two fold higher for males than females (47+/-9 vs 25+/-5mg/dl mean+/-SEM, p=0.05). CR resulted in a reduction in circulating Lp(a) in males to levels similar to those measured in calorie-restricted females, (27+/-5 vs 24+/-4 mg/dl mean+/-SEM). For all animals, plasma Lp(a) was correlated with total cholesterol (r=0.27, p=0.03) and LDL cholesterol (r=0.50, p=0.0001) whether unadjusted or after adjustment for treatment, gender or group. These studies introduce a new mechanism whereby CR may have a beneficial effect on risk factors for the development of atherosclerosis in primates.

Gender moderates the effects of exercise therapy on health-related quality of life among COPD patients.

STUDY OBJECTIVES: To determine whether long-term treatment with exercise therapy results in more favorable, disease-specific, health-related quality of life (HRQL) compared with short-term treatment with exercise therapy; and to determine whether there are gender differences in disease-specific HRQL among individuals randomized into the two treatment groups. DESIGN: Randomized clinical trial. SETTING: Center-based exercise therapy unit at a university. PARTICIPANTS: One hundred forty patients with COPD; 118 completed trial. INTERVENTIONS: Short-term exercise therapy (3 months); long-term exercise therapy (18 months). MEASUREMENTS: Chronic Disease Respiratory Questionnaire (CRQ). RESULTS: After 3 months of treatment, there were significant improvements in all CRQ scores for men and women (p < 0.01), and for the total sample (p < 0.01). At 18 months, individuals randomized into the long-term group had significantly more favorable scores than the short-term group for dyspnea (p = 0.03), fatigue (p < 0.01), emotional function (p = 0.04), and mastery (p = 0.04). However, these effects were moderated by gender. That is, men in the long-term group reported significantly more favorable scores than men in the short-term group for dyspnea (0.04), fatigue (p < 0.001), emotional function (p = 0.02), and mastery (p = 0.02). At the 18-month assessment, there were no differences between long-term and short-term exercise therapy for women on any of the subscales of the CRQ. CONCLUSIONS: Taken collectively, the CRQ data demonstrate that long-term exercise therapy has little added benefit for women over short-term exercise therapy; however, men derive significant benefits from extended training.

Cigarette smoking, low birth weight, and preterm births in low-income African American women.

OBJECTIVE: To examine effects of light and heavy cigarette smoking on the incidence of low birth weight (LBW) and preterm births in African American women. DESIGN: A total of 1146 low-income African American women participated in a randomized trial to test the effectiveness of nursing intervention in the reduction of preterm and LBW births. This secondary analysis focused on the effects of cigarette smoking on LBW (< 2500 gm) and preterm (< 37 weeks' gestation) births. RESULTS: Cigarette smoking had a significant effect on both LBW and preterm births. When light smokers were compared with nonsmokers, odds ratios were 1.89 (confidence interval (CI) 1.15, 3.13; p = 0.0127) for LBW births and 1.74 (CI 1.00; 3.02; p = 0.0499) for preterm births. When heavy smokers were compared with nonsmokers, odds ratios were 3.03 (CI 1.90, 4.86; p = 0.001) for LBW births and 2.60 (CI 1.55, 4.35; p = 0.0003) for preterm births. CONCLUSION: Cigarette smoking was associated with significantly higher rates of both LBW and preterm births in this sample of African American women.

Tobacco growers' knowledge of revenue distribution and foreign prices: implications for health education.

This study examined tobacco growers' knowledge of tobacco economics, particularly their knowledge of how tobacco revenue is distributed and their knowledge of the price of foreign tobacco. Tobacco growers (n = 1236) from 14 tobacco-dependent counties in North Carolina were interviewed by telephone and asked to estimate how much of a hypothetical $2.00 for a pack of cigarettes is received by each of four market segments: tobacco growers, retailers, government and manufacturers. Respondents were also asked to estimate the price of foreign raw tobacco. USDA data were used to assess the accuracy of the respondents' estimates. Respondents were within the 'correct' range as follows: growers 31%, retailers 15%, government 23%, manufacturers 43% and foreign prices 25%. Knowledge was positively related to education and farm size for the growers' share and foreign tobacco prices. Knowledge of the government's and manufacturers' shares was positively associated with younger age. North Carolina growers lacked knowledge of the distribution of the tobacco dollar. This may influence the positions that growers take on health policy and provide significant opportunities for health educators to become involved in grassroots efforts to educate growers.

Evaluating and understanding performance testing in COPD patients.

PURPOSE: There is increasing interest in the use of performance tests to assess physical function among patients with debilitating diseases. The purpose of this study was to describe the measurement properties of a performance test battery used in the Reconditioning Exercise and Chronic Obstructive Pulmonary Disease Trial and to explore how well-selected physiologic and psychosocial measures explained test performance. METHODS: To assess test-retest reliability of the performance tests, older patients with chronic obstructive pulmonary disease (n = 30) completed, on two different occasions, a 6-minute walk for distance, a timed stair climb, and a timed elevated-arm task. In addition, stepwise regression analyses were conducted on a larger sample (n = 209) to examine how effective conceptually relevant physiologic and psychosocial variables were at explaining variation in task performance. RESULTS: Results showed that all three performance tasks had good test-retest reliability (all coefficients > 0.80) and shared variance in expected directions with VO2peak, forced expiratory volume in 1 second (FEV1), and self-reported disability. Regression analyses suggest that VO2peak, FEV1, self-efficacy, and self-reported disability are important variables to consider in attempts to understand performance-related disability in patients with chronic obstructive pulmonary disease (COPD). CONCLUSIONS: The physical performance test battery appears to be a reliable means of assessing physical functioning in older patients with COPD. Furthermore, findings support the important role that VO2peak plays in task performance and suggest that patients' perceptions should be given careful consideration when attempting to understand physical decline in clinical settings.

Exercise rehabilitation and chronic obstructive pulmonary disease stage.

To determine the extent to which patients with Stage I COPD experience improvements in physical performance and quality of life as a result of exercise training, and to compare these improvements with those seen in Stage I and II patients, 151 patients with COPD underwent a 12-wk exercise program. Outcomes were measured at baseline and follow-up. Physical performance was evaluated by means of a 6-min walk, treadmill time, an overhead task, and a stair climb. General health-related quality of life was assessed in terms of the domains of Social Function, Health Perceptions, and Life Satisfaction. Disease-specific health-related quality of life was assessed with the Chronic Respiratory Disease Questionnaire (CRQ). Six-minute walk distance increased significantly in Stage I (200.5 ft [95% CI: 165.4, 235.7]), Stage II (238.3 ft [143.3, 333.3]), and Stage III (112.1 ft [34.6, 189.6]) participants. Treadmill time increased significantly in Stage I (0.42 min [0.20, 0.64]) and Stage II (0.64 min [0.14, 1.4]) participants. Time to complete the overhead task decreased significantly in Stage I (0.91 s [1.72, 0. 11]) and Stage II (1.39 s [2.66, 0.13]) participants. None of the measures of general health-related quality of life improved in any of the three groups. Participants in Stages I, II, and III all experienced improvements in the CRQ domains of dyspnea (0.72 [0.53, 0.91], 0.47 [0.02, 0.91], and 0.46 [0.05, 0.87], respectively) and fatigue (0.49 [0.33, 0.66], 0.54 [0.20, 0.87], and 0.55 [0.05, 1.05], respectively). These results suggest that all patients with COPD will benefit from exercise rehabilitation. Berry MJ, Rejeski WJ, Adair NE, Zaccaro D. Exercise rehabilitation and chronic obstructive pulmonary disease stage.

The relation of proinsulin and insulin to insulin sensitivity and acute insulin response in subjects with newly diagnosed type II diabetes: the Insulin Resistance Atherosclerosis Study.

AIMS/HYPOTHESIS: Proinsulin concentrations are increased relative to insulin concentrations in subjects with Type II (non-insulin-dependent) diabetes mellitus. This could be secondary to hyperglycaemia or insulin resistance or due to a defect in insulin secretion. METHODS: We investigated the association between fasting insulin, intact proinsulin and the intact proinsulin: insulin ratio with insulin sensitivity, estimated by a frequently sampled intravenous glucose tolerance test and the minimal model and with acute insulin response (AIR) in 182 newly diagnosed Type II diabetic subjects aged 40 to 69 years. None of the subjects was receiving hypoglycaemic medication. RESULTS: Insulin sensitivity correlated inversely with fasting insulin (r(s) = -0.42) and intact proinsulin (r(s) = -0.32) (p < 0.001). The intact proinsulin:insulin ratio was not correlated with insulin sensitivity. AIR correlated positively with intact proinsulin (r(s) = 0.23) and inversely with the intact proinsulin:insulin ratio (r(s) = -0.29, p < 0.001). Fasting glucose correlated positively with intact proinsulin (r(s) = 0.34) and the intact proinsulin:insulin ratio (r(s) = 0.24, p < 0. 001). The intact proinsulin:insulin ratio increased by decreasing AIR (quartiles of AIR from high to low: 7.8, 8.2, 9.7 and 12.1 %, p < 0.001). This association was independent of age, sex, ethnicity, body mass index, fasting glucose, and insulin sensitivity. CONCLUSION/INTERPRETATION: Insulin resistance (low insulin sensitivity) was not related to the intact proinsulin:insulin ratio in subjects with Type II diabetes. In contrast, both low AIR and high fasting glucose concentrations were associated with a disproportionate increase in proinsulin concentration. These results suggest that increased intact proinsulin:insulin ratio is a marker of a defect in insulin secretion in Type II diabetic subjects.

Peripartum cardiomyopathy: summary of an international survey on peripartum cardiomyopathy.

OBJECTIVE: The aim of this survey was to assess the evaluation, management, and future recommendations of patients with the diagnosis of peripartum cardiomyopathy and to evaluate the interest in the creation of a prospective database regarding this rare disorder. STUDY DESIGN: A total of 116 surveys were sent to major teaching institutions in the United States (including Puerto Rico), Canada, Crete, and South Korea after a national conference held at the National Institutes of Health regarding peripartum cardiomyopathy. This was an open-ended survey containing 17 specific questions regarding this disorder and its management. RESULTS: A total of 78 (67%) maternal-fetal specialists responded to the survey. Diuretics and digoxin were used as first-line treatment for this disorder. Only 6% used angiotensin-converting enzyme inhibitors during pregnancy. Fifty-eight percent of the perinatologists (58%) recommended either intrauterine contraceptive devices or foam and condoms, whereas oral contraceptives (progesterone-only pill or estrogen-progesterone mix) were recommended in 23% and 41%, respectively. Sixty-six percent (66%) of the respondents would recommend future pregnancy if ventricular function returned to normal. CONCLUSIONS: Fundamental clinical and basic research is lacking regarding this rare but potentially devastating disorder. Major teaching institutions do not have significant numbers of patients with this disorder to provide concrete recommendations, and starting a database will be useful in the gathering of important epidemiologic information. A secondary aim of such a registry would be to establish a repository for tissue and blood samples to answer basic mechanistic questions about this disorder.

Ventricular filling patterns of the right and left ventricles in normally grown fetuses: a longitudinal follow-up study from early intrauterine life to age 1 year.

OBJECTIVE: Our goal was to determine the effects of advancing age on the Doppler diastolic filling indexes from early gestation to 1 year of life. STUDY DESIGN: Seventy-nine fetuses were studied. Initial Doppler studies were started at about the 16th week of gestation and repeated every 4-6 weeks until term, on postnatal day 1 and 2, and at ages 6 weeks, 6 months, and 12 months. A minimum of 5 returning Doppler waveforms were traced and analyzed for (1) peak early flow velocity, (2) late peak atrial flow velocity, (3) total area area under the curve, and (4) the acceleration and deceleration phases. The stiffness of the ventricles was estimated. Slopes of the curves for each of the parameters were analyzed for differences across time periods and between right and left ventricles. RESULTS: (1) Heart rate significantly decreased with advancing age. (2) Left ventricular and right ventricular peak early flow velocity and late peak atrial flow velocity significantly increased during fetal life but not during the 1st year. (3) Atrial predominance was found during fetal life but not during the first year. (4) The deceleration phase of filling significantly increased during the fetal period. (5) Ventricular stiffness progressively decreased during the fetal period. (6) Increased ventricular filling shifted from a right-sided dominance in utero to a left-sided dominance after birth. CONCLUSIONS: (1) Fetuses have stiffer fetal ventricles than neonates. (2) The diastolic filling patterns in normally grown fetuses mimic those of the diseased adult heart. We speculate that this maturation process may be affected in fetuses born prematurely or small for gestational age.

Relative contribution of insulin and its precursors to fibrinogen and PAI-1 in a large population with different states of glucose tolerance. The Insulin Resistance Atherosclerosis Study (IRAS).

Hyperinsulinemia is associated with the development of coronary heart disease. However, the underlying mechanisms are still poorly understood. Hypercoagulability and impaired fibrinolysis are possible candidates linking hyperinsulinism with atherosclerotic disease, and it has been suggested that proinsulin rather than insulin is the crucial pathophysiological agent. The aim of this study was to investigate the relationship of insulin and its precursors to markers of coagulation and fibrinolysis in a large triethnic population. A strong and independent relationship between plasminogen activator inhibitor-1 (PAI-1) antigen and insulin and its precursors (proinsulin, 32-33 split proinsulin) was found consistently across varying states of glucose tolerance (PAI-1 versus fasting insulin [proinsulin], r=0.38 [r=0.34] in normal glucose tolerance; r=0.42 [r=0.43] in impaired glucose tolerance; and r=0.38 [r=0.26] in type 2 diabetes; all P<0.001). The relationship remained highly significant even after accounting for insulin sensitivity as measured by a frequently sampled intravenous glucose tolerance test. In a stepwise multiple regression model after adjusting for age, sex, ethnicity, and clinic, both insulin and its precursors were significantly associated with PAI-1 levels. The relationship between fibrinogen and insulin and its precursors was significant in the overall population (r=0.20 for insulin and proinsulin; each P<0.001) but showed a more inconsistent pattern in subgroup analysis and after adjustments for demographic and metabolic variables. Stepwise multiple regression analysis showed that proinsulin (split products) but not fasting insulin significantly contributed to fibrinogen levels after adjustment for age, sex, clinic, and ethnicity. Decreased insulin sensitivity was independently associated with higher PAI-1 and fibrinogen levels. In summary, we were able to demonstrate an independent relationship of 2 crucial factors of hemostasis, fibrinogen and PAI-1, to insulin and its precursors. These findings may have important clinical implications in the risk assessment and prevention of macrovascular disease, not only in patients with overt diabetes but also in nondiabetic subjects who are hyperinsulinemic.

Cigarette smoking, environmental tobacco smoke exposure and insulin sensitivity: the Insulin Resistance Atherosclerosis Study.

PURPOSE: To investigate whether active smoking and/or exposure to environmental tobacco smoke (ETS) is associated with insulin sensitivity. METHODS: Insulin sensitivity and tobacco use history were measured in 1481 participants in the Insulin Resistance Atherosclerosis Study (IRAS). IRAS is a large mulitcenter epidemiologic study designed to explore the cross-sectional relationships among insulin resistance, cardiovascular disease risk factors and behaviors, and disease in African-American, Hispanic, and non-Hispanic white men and women, aged 40-69 years, selected to represent a broad range of glucose tolerance. Multiple linear regression models and linear contrasts were employed to describe the association between smoking history, as assessed via structured interview, and insulin sensitivity, as assessed by an insulin modified frequently sampled intravenous glucose tolerance test (FSIGT) with minimal model analysis. RESULTS: Active smoking was not associated with insulin sensitivity. Exposure to ETS was associated with lower insulin sensitivity. Specifically, for all participants combined, levels of SI were lower, indicating reduced insulin sensitivity, for those exposed to ETS when compared to those who were not exposed (p = 0.019). This association persisted for female participants (p = 0.013) and exhibited the same trend for males but failed to achieve statistical significance (p = 0.264). CONCLUSIONS: Our study did not reveal an association between active smoking and insulin sensitivity, as has been shown previously. The association between ETS exposure and insulin sensitivity is a puzzling finding which deserves further investigation in the longitudinal data from IRAS as well as in other populations.

Relationships between insulin resistance and lipoproteins in nondiabetic African Americans, Hispanics, and non-Hispanic whites: the Insulin Resistance Atherosclerosis Study.

The study purpose was to explore the association between dyslipidemia and insulin resistance in three ethnic groups. The Insulin Resistance Atherosclerosis Study (IRAS) is a multicenter epidemiologic study conducted at four clinical centers in California, Texas, and Colorado. The study population for this analysis consisted of 931 non-Hispanic white, African American, and Hispanic men and women (aged 45 to 64 years) without diabetes. The IRAS clinical examinations included lipoprotein measures, a 75-g glucose tolerance test, and the frequently sampled intravenous glucose tolerance (FSIGT) test. The results show a consistent relationship between insulin-mediated glucose disposal and dyslipidemia in African American, Hispanic, and non-Hispanic white men and women. Further, LDL size was inversely associated with insulin resistance in all three ethnic groups. These findings indicate that dyslipidemia is a fundamental part of the insulin resistance syndrome in all of the ethnic groups studied.

A randomized trial of nurse intervention to reduce preterm and low birth weight births.

OBJECTIVE: To test the effect of telephone calls from registered nurses to low-income pregnant women on the rates of low birth weight (LBW) and preterm births. METHODS: A total of 1554 women receiving prenatal care in a public clinic who met study criteria and who consented were assigned randomly to intervention and control groups. Women in the intervention group received telephone calls from a registered nurse, one or two times weekly from 24 weeks' through 37 weeks' gestation. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. RESULTS: Low birth weight rates were 10.9% in the intervention group and 14.0% in the control group (RR 0.75; 95% CI 0.55, 1.03; P = .072). For gestational age less than 37 weeks, rates were 9.7 in the intervention group and 11.0 in the control group (RR .87; 95% CI 0.62, 1.22; P = .415). In the subgroup of low-income black women 19 years of age and older, a statistically significant difference was found in preterm birth rates before 37 weeks (8.7% in the intervention group versus 15.4% in the controls [RR 0.56; 95% CI 0.38, 0.84; P = .004]). CONCLUSION: There was no difference in LBW or preterm births between intervention and control groups in the total sample. In a secondary analysis of black subjects 19 years of age and older, there was a significant difference in preterm birth rates.

Microalbuminuria is associated with insulin resistance in nondiabetic subjects: the insulin resistance atherosclerosis study.

Microalbuminuria is associated with excess cardiovascular mortality in both diabetic and nondiabetic subjects. Patients with NIDDM and microalbuminuria are more insulin resistant than those without microalbuminuria. However, the relationship between insulin resistance and microalbuminuria in patients with NIDDM could be due to hyperglycemia, which can cause both insulin resistance and an increase in albumin excretion rate. Little is known about microalbuminuria and insulin resistance in nondiabetic subjects. Therefore, we examined, cross-sectionally, the relationship of insulin sensitivity (S(I) x 10(-4) min x microU(-1) x ml(-1)), estimated by a frequently sampled intravenous glucose tolerance test and the minimal model and fasting plasma insulin concentration, to microalbuminuria (albumin-to-creatinine ratio > or = 2 mg/mmol) in 982 nondiabetic subjects aged 40-69 years. Altogether, 15% of the subjects had microalbuminuria, and 32% had hypertension. Subjects with microalbuminuria had a lower degree of insulin sensitivity (means +/- SE, 1.70 +/- 0.11 vs. 2.25 +/- 0.07, P = 0.003) and higher fasting insulin concentrations (17.4 +/- 1.1 vs. 15.7 +/- 0.5 mU/l, P = 0.059) compared with subjects without microalbuminuria. In logistic regression analysis, an increasing degree of insulin sensitivity was related to a decreasing prevalence of microalbuminuria (odds ratio = 0.86, 95% CI: 0.79-0.94, P < 0.001). Although this relationship attenuated after adjustment for age, sex, ethnicity, hypertension, fasting glucose, and BMI, it still remained significant. The association between insulin sensitivity and microalbuminuria was shown not to be different between normotensive and hypertensive subjects. Our results suggest a relationship between insulin resistance and microalbuminuria in nondiabetic subjects that is partially dependent on blood pressure, glucose levels, and obesity.

Attitudes and practices of registered nurses toward women who have experienced abuse/domestic violence.

OBJECTIVE: To compare the education, attitudes, and practices related to domestic violence of perinatal nurses from three types of practice sites. DESIGN: A descriptive study of responses to a questionnaire administered to a convenience sample and through a mailing. SETTING: Education conferences and responses to a mailing. PARTICIPANTS: Two hundred seventy-five nurses in perinatal practice (87 public health, 71 hospital, 117 private office). MAIN OUTCOME MEASURES: Primary outcomes were attitudes and beliefs about domestic violence and nursing behavior when domestic violence was identified. The effects of education about domestic violence on practice and the effect of a personal/family history of domestic violence on practice were examined. RESULTS: Some differences were found in the attitudes and beliefs of nurses from different practice sites, but more differences were found in their behaviors. Only 54% of the total sample reported having education about domestic violence, received in formal or continuing education programs. Public health nurses were the most likely to have such education. Education affected both attitudes and behavior. In the total sample, 31% of nurses reported abuse of themselves or family members. CONCLUSIONS: Nursing care for women who have experienced domestic violence includes assessment and appropriate counseling. Many nurses in this study lacked education about domestic violence. The provision of education about abuse and domestic violence is a first step toward a change in nursing practice.

Hyperemic response of the brachial artery during the second half of pregnancy.

OBJECTIVE: To determine if women who developed preeclampsia had measurable differences in the vascular response postrelease of a 1-minute blood flow occlusion. METHODS: A total of 33 nulliparous patients were enrolled in this study during the second half of the pregnancy. All had baseline Doppler flow velocities while resting in the left lateral decubitus. Subsequently, a blood pressure cuff was inflated for 60 seconds in the forearm so as to occlude blood flow. Doppler waveforms were analyzed immediately after the release of the blood pressure cuff and on a single beat occurring at 15 second intervals for a total of five readings. After a rest period, patients were asked to squeeze a handheld manometer at maximum strength as long as possible. Doppler waveforms were analyzed as above. The Doppler waveforms of all enrolled patients who subsequently developed preeclampsia any time after the study were compared to those who remained normotensive. RESULTS: 1) The "hyperemic response" that occurred immediately after release of the blood pressure occlusion of the forearm was significantly different between patients who subsequently developed preeclampsia compared with those who remained normotensive, 2) the hyperemic response that occurred after the isometric handgrip exercise was not significantly different between the two groups, and 3) sensitivity, specificity, and negative predictive values were high, but positive predictive values were low. CONCLUSION: There was a significant difference in the hyperemic response of the brachial artery to a short period of ischemia of the forearm (blood pressure occlusion) between normotensive patients and a group of patients who subsequently developed preeclampsia.