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1.
Womens Health (Lond) ; 17: 17455065211042190, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34465268

RESUMO

OBJECTIVES: The COVID-19 pandemic has caused considerable stress throughout the world. Little is known about how postpartum women who gave birth during the early months of the pandemic were impacted. The purpose of this study was to explore and describe the associations between potential risk, protective factors, and psychological distress among postpartum women who gave birth during the early months of the COVID-19 pandemic. METHODS: Postpartum women over the age of 18 years who gave birth in the US hospitals between March and July of 2020 and spoke English completed a survey about their experiences. Demographic and health variables were measured via self-report. Stress was measured using the Perceived Stress Scale-10. Mastery was measured with the Pearlin Mastery Scale. Resilience was measured with the Connor-Davidson Resilience Scale-2. RESULTS: This study included 885 women. Participants had higher stress and lower resilience relative to pre-pandemic norms. Participants had high levels of depression, anxiety, and stress. Women who had an infant admitted to the neonatal intensive care unit had more stress. Income, full-time employment, and partnered relationships were associated with lower stress. Resilience and mastery were related to lower stress, depression, and anxiety. Black, Indigenous, or People of Color women showed higher stress and lower resiliency. Single women were likely to report lower levels of mastery than partnered women. CONCLUSION: Stress, depression, and anxiety were high in postpartum women in this study. Income, partnered relationships, and employment security, along with protective traits such as mastery and resilience, may reduce the impact of stress on postpartum women in a pandemic. Care models should be modified to support women during a pandemic. Health disparities exist in postpartum stress. Future interventions should focus on building resiliency and mastery and ensuring appropriate resources are available to postpartum women in a pandemic.


Assuntos
COVID-19/epidemiologia , Pandemias , Período Pós-Parto/psicologia , Estresse Psicológico/epidemiologia , Adulto , Ansiedade/epidemiologia , COVID-19/psicologia , Estudos Transversais , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , Gravidez , Fatores de Proteção , Angústia Psicológica , Resiliência Psicológica , Fatores de Risco , SARS-CoV-2 , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos/epidemiologia
2.
Am J Perinatol ; 38(11): 1201-1208, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34225372

RESUMO

OBJECTIVE: Limited data are available regarding family and financial well-being among parents whose infants were hospitalized during the 2019 coronavirus (COVID-19) pandemic. The study objective was to evaluate the family and financial well-being of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) during COVID-19. STUDY DESIGN: Parents were recruited for this online, cross-sectional survey via support groups on social media. Data collection was completed between May 18, 2020 and July 31, 2020. The final sample consisted of 178 parents, who had an infant hospitalized in an NICU between February 1, 2020 and July 31, 2020. The primary outcomes were impact on family life and financial stability, as measured by the Impact on Family scale, an instrument that evaluates changes to family life as a result of infant or childhood illness. RESULTS: Of the 178 parent respondents, 173 (97%) were mothers, 107 (59.4%) were non-Hispanic White, and 127 (69.5%) of the infants were born prematurely. Parents reported significant family impact and greater financial difficulty. Extremely premature infants, lower household income, parent mental health, and lower parental confidence were predictive of greater impacts on family life. CONCLUSION: Parents reported significant family and financial impacts during their infant's hospitalization amid COVID-19. Further studies are needed to guide clinical practice and inform family-supportive resources that can mitigate consequences to family well-being. KEY POINTS: · Impact of infant hospitalization in the context of COVID-19 is largely unknown.. · In a cohort of NICU parents during COVID-19, they reported changes to family life and finances.. · Greater impacts were reported by parents with lower income, confidence, and very premature infants..


Assuntos
COVID-19 , Criança Hospitalizada/psicologia , Saúde da Família , Hospitalização/economia , Saúde Mental , Pais/psicologia , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Saúde da Família/economia , Saúde da Família/estatística & dados numéricos , Feminino , Estresse Financeiro , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/psicologia , Masculino , SARS-CoV-2 , Estados Unidos/epidemiologia
3.
Adv Neonatal Care ; 21(3): 242-246, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34010856

RESUMO

BACKGROUND: The National Association of Neonatal Nurse Practitioners (NANNP) partnered with the National Certification Corporation (NCC) to invite all NCC-certified neonatal nurse practitioners (NNPs) to participate in a national survey on NNP compensation, workforce environment, and satisfaction measures. PURPOSE: To understand the current NNP compensation, benefits, and workforce environment. METHODS: An anonymous survey was sent to 6558 board-certified NNPs with 845 respondents. RESULTS: Most of the survey respondents (92%) are in direct patient care (n = 804) with 83% (n=703) working full time (35 hours or more). Those NNPs with less than 5 years' experience had a mean salary of $119,000 per year while more experienced NNPs (30-plus years) earned a mean salary of $134,000 per year. Half of the NNPs (51%) report high satisfaction with their scope of practice and role in their organization. Distribution of NNPs throughout the workforce is suboptimal, with 67% of the administrators indicating they do not have enough NNPs. IMPLICATIONS FOR PRACTICE AND RESEARCH: The 2020 NANNP workforce survey collected information on NNP compensation, benefits, work environment, and experiences. It identified areas of satisfaction, such as compensation with bonuses and pay increases, and acknowledged areas needing improvement such as the lack of diversity within the profession. Utilizing the results of the survey will help create a more diverse, well-educated, and informed workforce to ensure culturally competent NNPs remain relevant within the healthcare system.

4.
Adv Neonatal Care ; 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33783388

RESUMO

BACKGROUND: The NANN Research Summit has been providing a platform for neonatal scholarship and clinical inquiry for 15 years. As the discipline of nursing and nursing research continue to evolve, it is important to gain perspective on current trends and needs for areas of strength and growth. PURPOSE: To evaluate participant outcomes of the NANN Research Summit and determine opportunities for improvement. METHODS: A 9-question survey was sent to 90 past participants for the Research Summit years 2015-2019. RESULTS: Thirty-seven (41%) participants from 2015 to 2019 responded. Of those responding, 75% continued to pursue their presentation topic; 95% felt empowered to continue their research based on their Summit experience; 84% felt more comfortable presenting their research findings after attending; 84% felt confident in publishing research after attending the Summit, with 43% reporting publications. These accomplished results would not have been possible without Mead Johnson's support. In addition, 57% did not publish the work presented and 65% lacked continued mentorship. IMPLICATIONS FOR PRACTICE: A redesigned Summit is presented to address the priorities for growth and alignment with continued emphasis on collegiality among neonatal nurse scholars. The redesigned Summit will promote continued clinical inquiry as a result of intentional focus on mentorship and development of scholarship. IMPLICATIONS FOR RESEARCH: The data collected from this initial survey will continue to serve as the basis for future data collection. Continued evaluation of strengths and areas for growth including the number of publications and mentorship experience can lead to expansion of research for the Summit facilitators and participants.

5.
J Matern Fetal Neonatal Med ; : 1-15, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-33645396

RESUMO

BACKGROUND: Dysregulation of inflammatory processes is linked to perinatal complications yet a comprehensive description of cytokine levels throughout the perinatal period is lacking. We report prospective, serial levels of 29 unique cytokines measured in maternal blood during pregnancy, in the cord blood at birth, and in the neonatal blood. METHODS: Pregnant women (n = 140) for recruited from a Midwest tertiary medical center. Blood was obtained at five timepoints: 12-20 weeks, 24-28 weeks, and at labor in the women, umbilical cord at birth, 24-72 h in the newborn. Cytokine levels were analyzed using an electrochemiluminescence-based immunoassay. RESULTS: Levels for 29 cytokines were measured. The data were separated into two groups: pregnancies with (n = 82) and without major complications (n = 53) (preterm birth, preeclampsia, diabetes mellitus). Eighteen cytokines showed significant changes over time (p < .002). The majority of the cytokines were highest in the newborn. No differences in cytokine levels between complication groups were noted at any timepoint. CONCLUSIONS: This is the first known study to report prospective, serial cytokine levels throughout the perinatal period for pregnancies with/without complications. No differences in maternal cytokine levels between those with/without complications were detected; studies with a larger sample size would be needed to validate our current findings. Results also suggest cytokine dysregulation may be more localized to the placenta making it difficult to measure and predict during pregnancy using maternal systemic blood specimens.

6.
Nurs Open ; 8(2): 709-720, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33570300

RESUMO

AIMS: To test a model of psychosocial/cultural/biological risk factors for poor birth outcomes in Latina pregnant women. DESIGN: An observational study measuring acculturation, progesterone, cortisol, cotinine, age, marital status, income, stress, depressive symptoms and coping. We tested a structural equation model to predict risk. METHODS: We obtained a convenience sample (N = 515) of low medical risk pregnant Mexican American Hispanic women at 22-24 weeks of gestation. Bilingual research nurses collected data from blood, urine and questionnaires. Self-report measures were the Beck Depression Inventory-II, the Perceived Stress Scale, the Acculturation Rating Scale for Mexican Americans-II and the Brief Cope. We measured progesterone and cortisol in plasma and cotinine levels in urine by enzyme-linked immunoassays. RESULTS: A PLS-SEM model revealed that Mexican American Hispanic pregnant women who were younger, single, lower income, more acculturated and who had greater negative coping, stress and depression were most at risk for having earlier and smaller babies.


Assuntos
Hispano-Americanos , Americanos Mexicanos , Complicações na Gravidez , Aculturação , Feminino , Humanos , Lactente , Gravidez , Resultado da Gravidez , Gestantes , Fatores de Risco
7.
Arch Womens Ment Health ; 24(2): 217-229, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32851469

RESUMO

To synthesize literature addressing maternal distress and associated variables in response to infant hospitalization in the NICU. CINAHL, Medline, PubMed, PsychINFO, and Scopus were searched for studies addressing maternal distress during NICU hospitalization published between January 2009 and August 2019. The initial literature search yielded 862 articles. Articles were included for analysis if (a) they were peer-reviewed, (b) maternal distress was defined or measured, and (c) maternal distress occurred in the NICU. Ultimately, 33 articles were included for analysis. Distress symptoms were not consistently measured across the literature by one specific instrument. However, despite the variety of instruments, distress was prevalent in this population. Individual elements of maternal distress in the NICU include depression, anxiety, trauma, and post-traumatic stress symptoms. These elements often occur together and tend to follow a specific trajectory during hospitalization. This body of literature was inconsistent regarding the timing of distress measurement as well as the relationship between relevant associated variables (e.g., marital status or infant illness severity) and maternal distress. Additionally, researchers often excluded mothers of non-preterm infants and infants with congenital anomalies from investigation. Researchers and clinicians should carefully consider timing and instrumentation in their interpretations of maternal distress measurement during a NICU hospitalization. Future work should focus on developing a comprehensive, valid, and reliable screening tool for clinicians and researchers to use to identify maternal distress in the NICU. Additionally, future research should address gaps in the populations included in studies.


Assuntos
Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Ansiedade/diagnóstico , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Mães , Gravidez
9.
Clin Infect Dis ; 2020 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-32296830

RESUMO

BACKGROUND: Rapid screening for tuberculosis (TB) disease at intake into immigrant detention facilities allows for early detection and treatment. Detention facilities with U.S. Immigration and Customs Enforcement (ICE) Health Service Corps (IHSC) medical staffing utilize chest radiography and symptom screening as the primary screening for pulmonary TB (PTB) disease. This analysis describes the demographic, clinical, and microbiological characteristics of individuals identified with TB disease at these facilities. METHODS: We conducted a retrospective analysis to describe the population of immigrant detainees identified via chest radiograph with PTB disease between January 1, 2014 and December 31, 2016 at facilities with IHSC medical staffing. We collected demographic variables, clinical presentation, diagnostic testing results, and microbiological findings. We generated descriptive statistics and examined univariate and multivariate associations between the variables collected and symptomatic status. RESULTS: We identified 327 patients with confirmed PTB disease (incidence rate: 92.8 per 100,000); the majority of patients were asymptomatic (79.2%) at diagnosis. Adjusting for all other variables in the model, the presence of cavitary lesions, AFB smear positivity, and multi-lobar presentation were significantly associated with symptomatic status. Among all patients identified with TB disease who had a TST result recorded, 27.2% were both asymptomatic and TST negative, including those with smear positive disease. CONCLUSIONS: Asymptomatic PTB disease is a significant clinical entity among immigrant detainees and placement in a congregate setting calls for aggressive screening to prevent transmission. Early identification, isolation, and treatment of TB disease benefits not only the health of the patient, but also the surrounding community.

10.
Nurs Res ; 69(3): 244-248, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31917737

RESUMO

BACKGROUND: A known relationship exists between oxidative stress and preterm birth (PTB). However, few studies have measured oxidative stress prospectively in early or midpregnancy, and no studies have used electron paramagnetic resonance (EPR) spectroscopy prospectively to predict PTB. OBJECTIVE: The purpose of this study was to identify predictive relationships between antioxidants and reactive oxygen species (ROS), specifically, superoxide (O2), peroxynitrite (OONO), and hydroxyl radical (OH), using EPR spectroscopy, measured between 12 and 20 weeks of gestation and compare with the incidence of PTB. METHODS: Blood was obtained from pregnant women (n = 140) recruited from a tertiary perinatal center. Whole blood was analyzed directly for ROS, O2, OONO, and OH using EPR spectroscopy. Red blood cell lysate was used to measure antioxidants. PTB was defined as parturition at <37 weeks of gestation. RESULTS: No differences were found between ROS, O2, OONO, or OH with the incidence of PTB. Catalase activity, glutathione, and reduced/oxidized glutathione ratio were significantly lower with PTB. Logistic regression suggests decreased catalase activity in pregnant women is associated with increased odds of delivering prematurely. DISCUSSION: We prospectively compared antioxidants and specific ROS using EPR spectroscopy in pregnant women between 12 and 20 weeks of gestation with the incidence of PTB. Results are minimal but do suggest that antioxidants-specifically decreased catalase activity-in early pregnancy may be associated with PTB; however, these findings should be cautiously interpreted and may not have clinical significance.


Assuntos
Idade Gestacional , Estresse Oxidativo , Nascimento Prematuro/epidemiologia , Antioxidantes/análise , Espectroscopia de Ressonância de Spin Eletrônica , Feminino , Humanos , Gravidez , Estudos Prospectivos , Espécies Reativas de Oxigênio/sangue
11.
Pregnancy Hypertens ; 18: 99-102, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31586785

RESUMO

INTRODUCTION: Preeclampsia (PE), one of the most serious complications of pregnancy, is characterized by endothelial dysfunction and hypertension. The pathophysiology of the disease is still unknown; however, evidence suggests that placental and maternal oxidative stress promote the disease process. Several studies have assessed levels of oxidative stress during pregnancy, but after diagnosis of PE. However, few studies have examined oxidative stress before PE diagnosis. Thus, the present work was aimed to gain further insight into the role of oxidative stress prior to diagnosis of PE (i.e. 12-20 weeks of gestation) and to further understand and predict PE incidence. METHODS: Blood levels of superoxide (O2-) and erythrocyte antioxidants such as superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH) and oxidized glutathione (GSSG) levels were measured in 23 preeclamptic pregnant women and 91 women with normal pregnancies. We further used logistic regression of O2- and each antioxidant level as the main predictor variable for PE risk. RESULTS: CAT activity, GSH, and Total glutathione (TGSH) were significantly lower with All PE pregnant groups, whereas O2- levels were modestly, but significantly, higher in women with mild PE. Logistic regression analysis suggests increased CAT activity in pregnant women is associated with a decreased odds of being preeclamptic. CONCLUSION: CAT is the only antioxidant as shown in our study to be related to the severity of the disease and may be a promising predictor for PE. Further studies are warranted to investigate the use of CAT as a novel therapeutic for PE.


Assuntos
Estresse Oxidativo , Pré-Eclâmpsia/diagnóstico , Diagnóstico Pré-Natal , Adulto , Estudos de Casos e Controles , Feminino , Glutationa/sangue , Humanos , Estudos Longitudinais , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/fisiopatologia , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Superóxido Dismutase/sangue
12.
J Pediatr Health Care ; 33(6): 663-674, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256852

RESUMO

INTRODUCTION: Infant-caregiver attachment is crucial for an infant's immediate and long-term social-emotional development and health. Despite advocacy by the National Institute of Children's Health Quality for infant social-emotional development screening, there is a lack of identified tools for use in primary care. Therefore, we conducted a systematic review to identify caretaker-infant attachment self-report screening tools that would be feasible, reliable, and valid for use in primary care. METHOD: A systematic search identified 340 abstracts/articles, which were screened using inclusion and exclusion criteria. Twelve articles and six self-report attachment tools were examined for reliability, validity, and feasibility characteristics. RESULTS: Six caregiver-infant attachment self-report tools were identified. Establishment of feasibility, reliability, and validity are in the early stages. DISCUSSION: Potential infant-caretaker attachment screening tools were identified for use in primary care practices. Suggestions for research and practice include informal screening, additional psychometric testing, and development of policies supporting implementation of screening.


Assuntos
Cuidadores , Mães , Apego ao Objeto , Atenção Primária à Saúde , Inquéritos e Questionários/normas , Humanos , Lactente , Reprodutibilidade dos Testes
13.
Adv Neonatal Care ; 19(5): 394-401, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306234

RESUMO

BACKGROUND: The neonatal intensive care unit (NICU) can cause significant psychological distress in a mother. There is no common definition of maternal distress in the NICU currently in use. PURPOSE: To develop a clear conceptual understanding of maternal distress in the NICU using conceptual definitions and empirical findings. METHODS/SEARCH STRATEGY: A literature search was conducted using EBSCOhost, MEDLINE, CINAHL, PsychINFO, and Google Scholar. The concept analysis was guided by Walker and Avant's (2011) guide. FINDINGS/RESULTS: Maternal distress in the NICU consists of a combination of depressive, anxiety, trauma, and posttraumatic stress symptoms. The symptoms occur together on a spectrum and present differently in each mother. The antecedents to maternal distress are a NICU hospitalization and a perceived interruption to the transition to motherhood. Consequences of maternal distress in the NICU are issues with developing a healthy maternal-infant bond, adverse infant development, and decreased maternal quality of life. IMPLICATIONS FOR PRACTICE: A complete understanding of maternal distress in the NICU will lead to increased awareness of adverse mental health states in this population. IMPLICATIONS FOR RESEARCH: Identification of mothers at risk for maternal distress in the NICU, as well as the identification of antecedents and consequences related to the mother and the infant from maternal distress in the NICU. Using a single, clear definition of maternal distress in the NICU population will lead to a more cohesive body of literature.


Assuntos
Ansiedade/psicologia , Depressão Pós-Parto/psicologia , Relações Mãe-Filho , Mães/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/psicologia , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Masculino , Qualidade de Vida , Fatores de Risco
14.
Adv Neonatal Care ; 19(6): 490-499, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31306236

RESUMO

BACKGROUND: Provider-parent communication is a critical determinant of how neonatal intensive care unit (NICU) parents cope, yet staff feel inadequately trained in communication techniques; many parents are not satisfied with the support they receive from hospital providers. PURPOSE: This study evaluated whether NICU staff would demonstrate improved knowledge and attitudes about providing psychosocial support to parents after taking an online course. METHODS: After providing demographic information, staff at 2 NICUs took a 33-item survey both before and after taking a 7-module online course "Caring for Babies and Their Families," and again at 6-month follow-up. Scores (means ± standard deviation) from all time periods were compared and effect sizes calculated for each of the course modules. RESULTS: NICU staff participants (n = 114) included nurses (88%), social workers (7%), physicians (4%), and occupational therapists (1%). NICU staff showed significant improvement in both knowledge and attitudes in all modules after taking the course, and improvements in all module subscores remained significant at the 6-month follow-up mark. Night staff and staff with less experience had lower pretest scores on several items, which improved on posttest. IMPLICATIONS FOR PRACTICE: This course, developed by an interprofessional group that included graduate NICU parents, was highly effective in improving staff knowledge and attitudes regarding the provision of psychosocial support to NICU parents, and in eliminating differences related to shift worked and duration of work experience in the NICU. IMPLICATIONS FOR RESEARCH: Future research should evaluate course efficacy across NICU disciplines beyond nursing, impact on staff performance, and whether parent satisfaction with care is improved.


Assuntos
Atitude do Pessoal de Saúde , Educação à Distância/métodos , Terapia Intensiva Neonatal/psicologia , Enfermagem Neonatal , Pais/psicologia , Sistemas de Apoio Psicossocial , Escolaridade , Inteligência Emocional , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Enfermagem Neonatal/educação , Enfermagem Neonatal/métodos , Inquéritos e Questionários
15.
Biol Res Nurs ; 21(5): 485-494, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31284724

RESUMO

BACKGROUND: Oxidative stress is associated with poor perinatal outcomes. Little is known regarding the longitudinal levels of oxidative stress in the perinatal period or the correlation between maternal and neonatal oxidative stress levels. OBJECTIVE: Describe and compare oxidative stress, specifically superoxide, superoxide dismutase, catalase, and glutathione levels, over the perinatal period. STUDY DESIGN: Longitudinal descriptive design using a convenience sample of medically high- and low-risk pregnant women (n = 140) from a maternal-fetal medicine and general obstetrics practice, respectively. Blood was obtained from women at 12-20 and 24-28 weeks' gestation and during labor, from the umbilical cord at birth, and from neonates at 24-72 hr after birth. Levels of superoxide were measured using electron paramagnetic resonance (EPR) spectroscopy; antioxidants (superoxide dismutase, catalase, and glutathione) were measured using commercial assay kits. Relationships between oxidative stress levels at different time points were examined using nonparametric methods. Pregnancy outcome was collected. RESULTS: Demographic variables, outcome variables, and oxidative stress levels in maternal blood, cord blood, and infants differed between medically high- and low-risk women. Descriptive patterns for oxidative stress measures varied over time and between risk groups. Significant correlations between time points were noted, suggesting intraindividual consistency may exist throughout the perinatal period. However, these correlations were not consistent across each medical risk group. CONCLUSION: EPR spectroscopy is a feasible method for the perinatal population. Results provide new information on perinatal circulating superoxide levels and warrant further investigation into potential relationships between prenatal and neonatal physiologic dysregulation of oxidative stress.


Assuntos
Antioxidantes/metabolismo , Sangue Fetal/química , Recém-Nascido/sangue , Estresse Oxidativo , Placenta/metabolismo , Adulto , Biomarcadores/sangue , Feminino , Humanos , Estudos Longitudinais , Troca Materno-Fetal , Gravidez , Resultado da Gravidez , Superóxido Dismutase/sangue
16.
Nurs Res ; 68(2): 167-173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829924

RESUMO

BACKGROUND: Allostatic load (AL) is a biopsychosocial model that suggests chronic psychosocial stress leads to physiological dysregulation and poor outcomes. The purpose of this study was to examine AL in pregnant women operationalized using proinflammatory cytokines and psychosocial indicators and perinatal outcomes. OBJECTIVES: The aim of the study was to identify relationships between circulating cytokines/chemokines and the Prenatal Distress Questionnaire, the Maternal Antenatal Attachment Scale, the Emotional Quotient Inventory, the Life Experiences Scale, and demographics in pregnant women. METHODS: A cross-sectional design was used to recruit pregnant women between 24 and 28 weeks of gestation. Blood and stress/emotional indicators were obtained after informed consent. Plasma was abstracted to simultaneously measure 29 cytokines/chemokines using a multiplex array. Cytokine/chemokine levels were compared with continuous variables using Spearman's rho and with categorical variables using Mann-Whitney U. RESULTS: Twenty-five women with medically high-risk (n = 16) and low-risk (n = 9) pregnancies consented. Most women were White (68%) with a mean age of 29 years (SD = 5.9). Although several cytokines and chemokines showed significant correlations with the stress/emotional indicators, only interleukin-17A (IL-17A) was significantly associated with all of the indicators (Prenatal Distress Questionnaire: rs = .528, p = .012; Maternal Antenatal Attachment Scale: rs = -.439, p = .036; Emotional Quotient Inventory total: rs = -.545, p = .007), Life Experiences Scale (rs = .458, p = .032), birth weight (rs = -.499, p = .013), and race (p = .01). DISCUSSION: Increased levels of IL-17A, a known cytokine associated with chronic stress and with poor perinatal outcomes, were associated with high prenatal distress, low maternal attachment, and lower emotional intelligence in pregnant women. Increased levels of IL-17A also were associated with lower birth weight and non-White race. Results support the model of AL in pregnant women and highlight IL-17A as a potential biomarker of AL during pregnancy.


Assuntos
Interleucina-17/sangue , Complicações na Gravidez/imunologia , Proteínas da Gravidez/sangue , Estresse Psicológico/imunologia , Adulto , Biomarcadores/sangue , Estudos Transversais , Citocinas/sangue , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez/imunologia
17.
Antioxidants (Basel) ; 8(1)2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30609664

RESUMO

Studies have shown an increased risk for a variety of cancers, specifically brain cancer, in healthcare workers occupationally exposed to ionizing radiation. Although the mechanisms mediating these phenomena are not fully understood, ionizing radiation-mediated elevated levels of reactive oxygen species (ROS), oxidative DNA damage, and immune modulation are likely involved. A group of 20 radiation exposed workers and 40 sex- and age-matched non-exposed control subjects were recruited for the study. We measured superoxide (O2•-) levels in whole blood of healthcare workers and all other measurements of cytokines, oxidative DNA damage, extracellular superoxide dismutase (EcSOD) activity and reduced/oxidized glutathione ratio (GSH/GSSG) in plasma. Levels of O2•- were significantly higher in radiation exposed workers compared to control. Similarly, a significant increase in the levels of interleukin (IL)-6, IL-1α and macrophage inflammatory protein (MIP)-1α in radiation exposed workers compared to control was observed, while there was no significance difference in the other 27 screened cytokines. A significant positive correlation was found between MIP-1α and O2•- levels with no correlation in either IL-6 or IL-1α. Further, a dose-dependent relationship with significant O2•- production and immune alterations in radiation exposed workers was demonstrated. There was no statistical difference between the groups in terms of oxidative DNA damage, GSH/GSSG levels, or EcSOD activity. Although the biologic significance of cytokines alterations in radiation exposed workers is unclear, further studies are needed for determining the underlying mechanism of their elevation.

18.
Biol Res Nurs ; 20(5): 497-512, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30068228

RESUMO

BACKGROUND: A variety of methods and measures have been used to quantify oxidative stress in clinical studies related to preterm birth (PTB), and studies have reported conflicting findings. No integrative reviews have been conducted. OBJECTIVE: To describe specific molecules used as markers of oxidative stress and methods to measure these molecules and to review the literature for associations between oxidative stress and PTB specific to these molecules. METHOD: Systematic literature searches were conducted in June 2015 and updated in 2017 in databases from the Biomedical Reference Collection: Basic Edition, including MEDLINE and clinicaltrials.gov . Articles were included if they described original research published after 2009 and compared PTB or preterm premature rupture of membranes with term birth (TB). RESULTS: Abstracts ( n = 3,107) were reviewed for inclusion/exclusion criteria. Of these, 308 were full-text reviewed, and 30 articles were included in this review. All were identified as nonexperimental. The most common measurements of oxidative stress were quantification of total oxidant or antioxidant status or lipid peroxidation. Studies measuring reactive oxygen species or by-products of oxidative stress reported higher levels of these molecules for preterm specimens compared to TB specimens. Studies measuring antioxidants reported lower levels for these molecules in PTB specimens. Few of the studies had inconclusive findings. DISCUSSION: Findings suggest that an imbalance between oxidants and antioxidants may be associated with PTB. The measurements and findings to date limit interpretation and understanding. Research using multidimensional methods and multidisciplinary teams are necessary to advance research and practice.


Assuntos
Antioxidantes/análise , Antioxidantes/fisiologia , Biomarcadores/análise , Estresse Oxidativo/fisiologia , Nascimento Prematuro/fisiopatologia , Espécies Reativas de Oxigênio/análise , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Gestantes
19.
ANS Adv Nurs Sci ; 41(3): 203-215, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29901466

RESUMO

This scoping review examined research on transitions among emerging adults, 18- to 30-year-olds, to identify designs, populations, frameworks, transition types, and transition outcomes. A librarian conducted the search, yielding 2067 articles. Using predefined criteria, teams screened abstracts and reviewed articles, with 82% to 100% interrater agreement. Data from the final 160 articles were placed in evidence tables and summarized. Most frequently, the studies had exploratory-descriptive designs (69%), nondiagnosed samples (58%), no theoretical frameworks (58%), developmental transitions (34%), and health-related behavior outcomes (34%). This transition research is in an early stage of knowledge development and would benefit from further theory development.


Assuntos
Comportamentos Relacionados com a Saúde , Estilo de Vida , Qualidade de Vida , Estresse Psicológico , Adaptação Psicológica , Adulto , Atitude Frente a Saúde , Humanos , Adulto Jovem
20.
J Neonatal Nurs ; 23(3): 134-141, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28503081

RESUMO

PURPOSE: Identifying relationships between feeding intolerance (FI), inflammation, and early measures of neurodevelopment may provide the basis for clinically relevant assessments for NICU clinicians and staff. The purpose of this secondary analysis was to examine the relationship of FI to inflammatory markers and/or neurobehaviors in the first week of life. METHODS: This was a retrospective, matched case-control design with data drawn from 114 infants born at ≤32 weeks gestation. RESULTS: Eight infants developed FI prior to full enteral feedings. These infants were more likely to have dysregulated levels of cytokines, specifically IL6, and lower neurodevelopmental scores compared to infants without FI. CONCLUSIONS: Results suggest physiologic dysregulation and an immature nervous system may contribute to the phenomenon of FI in preterm infants. Further research to identify the role of the brain-gut-immune axis on FI and other GI complications in this population is warranted.

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