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1.
J Forensic Nurs ; 15(4): 199-205, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31764523

RESUMO

Initial conceptualizations of violence and trauma in forensic nursing have remained relatively narrowly defined since the specialty's inception. The advent of trauma-informed care has been important but has limitations that obfuscate social and structural determinants of health, equity, and social justice. As forensic nursing practice becomes more complex, narrow definitions of violence and trauma limit the effectiveness of trauma-informed care in its current incarnation. In keeping with the nursing model of holistic care, we need ways to teach, practice, and conduct research that can accommodate these increasing levels of complexity, including expanding our conceptualizations of violence and trauma to advance health equity and social justice. The objective of this article is to introduce the concepts of structural violence and trauma- and violence-informed care as equity-oriented critical paradigms to embrace the increasing complexity and health inequities facing forensic nursing practice.


Assuntos
Enfermagem Forense , Equidade em Saúde , Trauma Psicológico/enfermagem , Justiça Social , Vítimas de Crime , Currículo , Educação em Enfermagem , Política de Saúde , Disparidades nos Níveis de Saúde , Humanos , Pesquisa em Enfermagem
2.
J Interpers Violence ; : 886260519827161, 2019 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-30741071

RESUMO

The Domestic Violence Enhanced Home Visitation (DOVE) intervention used in the Perinatal Nurse Home Visiting Intervention Enhanced With mHealth Technology (RCT: R01HD071771) is a nurse-lead evidenced-based intervention that has been shown to decrease violence overtime. This summative mixed-methods impact evaluation is intended to provide insight to enhance the DOVE IPV protocol for screening and intervention by (a) identifying which core aspects of DOVE facilitated or inhibited its success and what was most critical to optimal IPV (intimate partner violence) screening and intervention practices, (b) informing how DOVE IPV screening and intervention were influenced by the experiences of home visitor (HV), and (c) identifying policy considerations and best practice recommendations for the DOVE protocol. Participants were HVs and managers ( N = 13) in rural/urban home visiting programs delivering DOVE across three states. The sample had a mean age of 48.76. Three fourths were baccalaureate-prepared nurses with an average of 10.5 years of home visiting experience. The method used in this study was one-to-one qualitative in-depth interviews with HVs. Data were interpretively analyzed using Nvivo 10 to generate three themes. Participants endorsed screening women for IPV with DOVE being the approach of choice to facilitate IPV screening and intervening with women. HVs found DOVE helped enhance their IPV knowledge, screening, and intervening capabilities while filling an existing void in this type of preparation of HV nurses. Establishing a relationship with the women before initiating screening was an important aspect in delivering DOVE as was the training, support, and increased comfort level in addressing IPV. The evidence offers an understanding of which core aspects of DOVE contributed to its success and what was most critical to optimal IPV screening and intervention practices. Furthermore, this evaluation provided multilevel insights into how best to advance home visiting practices and policies when screening and intervening with perinatal women exposed to IPV.

3.
J Obstet Gynecol Neonatal Nurs ; 48(1): 50-58, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30391221

RESUMO

OBJECTIVE: To examine the prevalence, correlates, and influences of male partner reproductive coercion (RC) and intimate partner violence (IPV) on unintended pregnancy (UIP). DESIGN: Retrospective cohort study using population-based data. SETTING: Six participating states contributed data from the Pregnancy Risk Assessment Monitoring System (PRAMS). PARTICIPANTS: Data were obtained for 20,252 women who gave birth between 2012 and 2015 and completed the PRAMS survey within 9 months of giving birth. METHODS: Weighted descriptive statistics and multivariate logistic regression models were used to assess the influence of RC and IPV on odds of UIP. RESULTS: Approximately 2.7% (n = 600) of participants reported physical IPV, and 1.1% (n = 285) reported RC. Participants less than 30 years of age, with low socioeconomic status, who were single and of Black or Hispanic race/ethnicity were at significantly increased risk of IPV. With the exception of Hispanic race/ethnicity, these sociodemographic characteristics were also associated with an increased risk for RC. Participants who experienced IPV had a nearly eightfold increased risk of RC (adjusted odds ratio = 7.98, 95% confidence interval [CI] [4.68, 13.59]) than their nonabused counterparts. In univariate models, RC, IPV, or RC with IPV were significantly associated with increased odds of UIP (odds ratio [OR] = 2.18, 95% CI [1.38, 3.44]; OR = 2.36, 95% CI [1.75, 3.19]; OR = 3.55, 95% CI [1.56, 8.06], respectively); however, results were nonsignificant after adjusting for sociodemographic factors. CONCLUSION: In this population-based sample, we confirmed that there were links among IPV, RC, and UIP, all factors associated with poor maternal and infant outcomes. Screening for IPV and RC is an important step toward reducing rates of UIP.

4.
J Pediatr Nurs ; 42: 1-8, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30219293

RESUMO

PURPOSE: Despite the evidence, the availability since 2006, and strong recommendations from many professional organizations, the human papillomavirus (HPV) vaccine has had a low uptake rate nationally and these trends have been even lower in the state of Virginia. DESIGN AND METHODS: We explored key stakeholders' perspectives on factors influencing HPV vaccination in central and southern Virginia organized within the socio-ecological model (SEM) framework. We conducted semi-structured key informant interviews with 31 stakeholders involved in HPV vaccination or cancer prevention. RESULTS: Stakeholders identified barriers at all SEM levels: Knowledge gaps and sexuality concerns (parent-child dyad level), time constraint and inconsistent recommendation (interpersonal level), lack of leadership and informational support (organizational and community level), and an ineffective mandate (policy level). Facilitators identified were realistic/receptive attitude (parent-child dyad level), provider's strong recommendation and educational support (interpersonal level), team approach and useful data (organizational level), educational outreach and community resources (community level), and support from federal and professional organizations (policy level). CONCLUSIONS: The stakeholder analysis provided an environmental scan of the barriers and facilitators so that an effective HPV vaccination strategy can be planned and implemented in the Commonwealth of Virginia by public health nurses.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Vacinação/estatística & dados numéricos , Adolescente , Feminino , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias do Colo do Útero/prevenção & controle , Vacinação/psicologia , Virginia
5.
Qual Health Res ; 28(11): 1708-1718, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30027811

RESUMO

There is increasing evidence that women are receiving a traumatic brain injury (TBI) during episodes of intimate partner violence (IPV), but little qualitative research exists around how surviving this experience impacts the lives of women. Primary and secondary data ( N = 19) were used with a constructivist grounded theory approach to explore the lives of women aged 18 to 44 years, who were living with a TBI from IPV. Women described multiple aspects of living in fear that shaped their daily lives and ability to seek help and access resources. The central process of prioritizing safety emerged, with salient dimensions of maintaining a present orientation, exhibiting hyperprotection of children, invoking isolation as protection, and calculating risk of death. These findings add to the growing body of knowledge that women living with IPV are at high risk for receiving a TBI and are therefore a subgroup in need of more prevention and treatment resources.


Assuntos
Lesões Encefálicas Traumáticas/psicologia , Medo , Violência por Parceiro Íntimo/psicologia , Adolescente , Adulto , Feminino , Teoria Fundamentada , Humanos , Entrevistas como Assunto , Poder Familiar/psicologia , Pessoalidade , Pobreza , Pesquisa Qualitativa , Isolamento Social/psicologia , Fatores Socioeconômicos , Adulto Jovem
6.
Biol Res Nurs ; 20(3): 292-299, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29490472

RESUMO

OBJECTIVE: To evaluate relationships between hair cortisol levels and perceived stress in mothers who deliver preterm and term. We hypothesized that the rate of change in cortisol levels would be greater in the preterm delivery group. METHODS: This preliminary study compared hair cortisol levels and Perceived Stress Scale (PSS) scores in predominately Caucasian mothers who delivered preterm ( n = 22) and term ( n = 30). We collected PSS and hair samples of ≥10 cm in length from mothers after delivery. Hair was segmented into three sections, and cortisol was measured using enzyme-linked immunosorbent assay. RESULTS: The mean gestational age was 31.45 ( SD = 4.2) weeks for preterm deliveries and 39.45 ( SD = 1.1) for term. Cortisol differed significantly in the third trimester between mothers delivering term and preterm ( t = 2.16, df = 48, p = .04) and trended toward significance in the second trimester ( t = 1.88, df = 48, p = .06). PSS differed significantly between the two groups ( t = -2.96, df = 50, p = .05). Our data did not provide support for our hypothesis. CONCLUSION: There appeared to be a blunted, flattened pattern of change in cortisol levels across gestation in the women who delivered preterm, suggesting diminished hypothalamic-pituitary-adrenal axis responsiveness in mechanisms that promote preterm labor. Future studies are needed to further evaluate best strategies for measuring the mechanisms of allostatic load during pregnancy along with the psychoneuroendocrine and immune triggers and placental responses that lead to premature birth.


Assuntos
Cabelo/metabolismo , Hidrocortisona/metabolismo , Mães , Nascimento Prematuro/metabolismo , Estresse Psicológico/metabolismo , Adulto , Feminino , Idade Gestacional , Humanos , Sistema Hipotálamo-Hipofisário , Recém-Nascido , Sistema Hipófise-Suprarrenal , Gravidez , Terceiro Trimestre da Gravidez/metabolismo , Trimestres da Gravidez/metabolismo , Adulto Jovem
7.
Hisp Health Care Int ; 15(2): 79-87, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28558498

RESUMO

INTRODUCTION: Intimate partner violence (IPV) is a global public health and criminal justice concern with significant impacts; especially high rates are seen among rural Hispanic American (HA) communities, the fastest growing population in the United States. They experience additional barriers to care including extreme poverty, lesser education, gender norms, and language and immigration issues. METHOD: A systematic literature review was conducted using Cooper's framework to identify evidence supporting associations between interventions and prevention, reduction, and elimination of IPV among rural HA women. Searches conducted on databases including CINAHL, PubMed, Medline, Women's Studies International, MedicLatina, and JSTOR used the MeSH terms Hispanic Americans (Latino/a and Hispanic), domestic violence, and intimate partner violence. Selected studies were published between January 1, 2000, and January 1, 2014. RESULTS: Of the 617 yielded articles, only 6 met the inclusion criteria. Of these, none closely examined rurality or provided valid and reliable measures of outcomes, instead reporting program descriptions and suggested interventions. We identify key findings to guide program, screening, and tool development. CONCLUSION: Our study identifies a gap in knowledge, research, and effective practices and issues a call for action to create evidence-based tools to prevent, reduce, and eliminate IPV in these underserved populations.


Assuntos
Promoção da Saúde/organização & administração , Hispano-Americanos , Violência por Parceiro Íntimo/etnologia , Violência por Parceiro Íntimo/prevenção & controle , População Rural , Prática Clínica Baseada em Evidências , Feminino , Humanos , Estados Unidos
8.
J Med Internet Res ; 18(11): e302, 2016 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-27856405

RESUMO

BACKGROUND: Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored. OBJECTIVE: Our objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors' and women's perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method. METHODS: We used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the 2 DOVE program designers. Nonparticipant observations of home visits with trial participants who chose not to participate in semistructured interviews were undertaken. RESULTS: We conducted 51 interviews with 26 women, 23 home visiting staff at rural and urban sites, and the 2 DOVE program designers. We conducted 4 nonparticipant observations. Among 18 IPV-positive women, 7 used the computer tablet and 11 used the home visitor method. Among 8 IPV-negative women, 7 used the home visitor method. The computer tablet was viewed as a safe and confidential way for abused women to disclose their experiences without fear of being judged. The meanings that the DOVE technology held for home visitors and women led to its construction as either an impersonal artifact that was an impediment to discussion of IPV or a conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women's and home visitors' comfort with either method of screening was positively influenced by factors such as having established trust and rapport, as well as good interpersonal communication. The technology helped reduce the anticipated stigma associated with disclosing abuse. The didactic intervention video was a limiting feature, as the content could not be tailored to accommodate the fluidity of women's circumstances. CONCLUSIONS: Users and developers of technology-based IPV interventions need to consider the context in which they are being embedded and the importance of the patient-provider relationship in promoting behavior change in order to realize the full benefits. An mHealth approach can and should be used as a tool for initiating discussion about IPV, assisting women in enhancing their safety and exploring help-seeking options. However, training for home visitors is required to ensure that a computer tablet is used to complement and enhance the therapeutic relationship. CLINICALTRIAL: Clinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitation.org/6limSWdZP).


Assuntos
Visita Domiciliar , Assistência Perinatal/métodos , Maus-Tratos Conjugais/prevenção & controle , Telemedicina/métodos , Adolescente , Adulto , Feminino , Humanos , Gravidez , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados Unidos , Adulto Jovem
9.
Public Health Nurs ; 33(6): 547-557, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27592689

RESUMO

Black Americans have disproportionately higher incidence and mortality rates for many cancers. These disparities may be related to genomic changes that occur from exposure to chronic toxic stress and may result from conditions associated with living in racially segregated neighborhoods with high rates of concentrated poverty. The purpose of this article is to present a nursing research framework for developing and testing neighborhood-level interventions that have the potential to mitigate exposure to neighborhood-associated chronic toxic stress, improve individual-level genomic sequelae and cancer outcomes, and reduce cancer health disparities of Black Americans. Public health nursing researchers should collaborate with local officials to determine ways to reduce neighborhood-level stress. Intermediate outcomes can be measured using genomic or other stress biomarkers, and long-term outcomes can be measured by evaluating population-level cancer incidence and mortality.


Assuntos
Afro-Americanos/genética , Afro-Americanos/psicologia , Exposição Ambiental/efeitos adversos , Disparidades nos Níveis de Saúde , Neoplasias/etnologia , Características de Residência/estatística & dados numéricos , Estresse Psicológico/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Feminino , Genômica , Humanos , Masculino , Neoplasias/genética , Pesquisa em Enfermagem , Pobreza , Enfermagem em Saúde Pública
10.
J Womens Health (Larchmt) ; 25(11): 1129-1138, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27206047

RESUMO

BACKGROUND: Perinatal intimate partner violence (IPV) is common and has significant negative health outcomes for mothers and infants. This study evaluated the effectiveness of an IPV intervention in reducing violence among abused women in perinatal home visiting programs. MATERIALS AND METHODS: This assessor-blinded multisite randomized control trial of 239 women experiencing perinatal IPV was conducted from 2006 to 2012 in U.S. urban and rural settings. The Domestic Violence Enhanced Home Visitation Program (DOVE) intervention group (n = 124) received a structured abuse assessment and six home visitor-delivered empowerment sessions integrated into home visits. All participants were screened for IPV and referred appropriately. IPV was measured by the Conflicts Tactics Scale2 at baseline through 24 months postpartum. RESULTS: There was a significant decrease in IPV over time (F = 114.23; p < 0.001) from baseline to 1, 3, 6, 12, 18, and 24 months postpartum (all p < 0.001). Additional models examining change in IPV from baseline indicated a significant treatment effect (F = 6.45; p < 0.01). Women in the DOVE treatment group reported a larger mean decrease in IPV scores from baseline compared to women in the usual care group (mean decline 40.82 vs. 35.87). All models accounted for age and maternal depression as covariates. CONCLUSIONS: The DOVE intervention was effective in decreasing IPV and is brief, thereby facilitating its incorporation within well-woman and well-child care visits, as well as home visiting programs, while satisfying recommendations set forth in the Affordable Care Act for IPV screening and brief counseling.


Assuntos
Mulheres Maltratadas/estatística & dados numéricos , Violência Doméstica/prevenção & controle , Visita Domiciliar/estatística & dados numéricos , Violência por Parceiro Íntimo/prevenção & controle , Assistência Perinatal/normas , Adolescente , Adulto , Animais , Violência Doméstica/estatística & dados numéricos , Prática Clínica Baseada em Evidências , Feminino , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Modelos Lineares , Patient Protection and Affordable Care Act , Período Pós-Parto , Gravidez , População Rural , Estados Unidos , População Urbana , Adulto Jovem
11.
Res Nurs Health ; 39(4): 286-97, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27176912

RESUMO

With increasing access to population-based data and electronic health records for secondary analysis, missing data are common. In the social and behavioral sciences, missing data frequently are handled with multiple imputation methods or full information maximum likelihood (FIML) techniques, but healthcare researchers have not embraced these methodologies to the same extent and more often use either traditional imputation techniques or complete case analysis, which can compromise power and introduce unintended bias. This article is a review of options for handling missing data, concluding with a case study demonstrating the utility of multilevel structural equation modeling using full information maximum likelihood (MSEM with FIML) to handle large amounts of missing data. MSEM with FIML is a parsimonious and hypothesis-driven strategy to cope with large amounts of missing data without compromising power or introducing bias. This technique is relevant for nurse researchers faced with ever-increasing amounts of electronic data and decreasing research budgets. © 2016 Wiley Periodicals, Inc.


Assuntos
Coleta de Dados , Interpretação Estatística de Dados , Funções Verossimilhança , Adulto , Feminino , Humanos
12.
MCN Am J Matern Child Nurs ; 41(3): 162-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27128642

RESUMO

PURPOSE: Determine the extent that participation in Resource Mothers Program (RMP) home visiting improves maternal health at 3 months postpartum. STUDY DESIGN AND METHODS: A randomized controlled trial using RMPs in two urban and one rural location in a mid-Atlantic state. Community health workers from these RMPs enrolled teens into the study and the research team assigned participants to either the intervention group or telephone support control group using computerized randomization assignments. Data collection from baseline and 3 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS) and the Prenatal Psychosocial Profile (PPP) is reported. RESULTS: The sample included 150 pregnant teens with a mean age of 17 years. Mean self-esteem scores between groups were not significantly different at baseline, but the RMP group self-esteem scores improved significantly at the 3 months postpartum interview (36.40 ± 5.63 for RMP vs. 34.10 ± 4.29 telephone control group, p = 0.049). Neither group was at risk for depression at baseline or 3 months postpartum. Because 60% of the total sample identified as Hispanic, post hoc analysis revealed significantly different baseline stress mean scores between Hispanic and non-Hispanic teens (p = 0.038); however, these differences were no longer significant by 3 months postpartum (p = 0.073). The EPDS scores by ethnicity were not different at baseline (p = 0.875) but were significantly different at 3 months (p = 0.007). CLINICAL IMPLICATIONS: The RMP home-visiting intervention can lead to improved self-esteem scores in teens, particularly in Hispanic teens. Improved self-esteem has been shown to lead to better parenting.


Assuntos
Visita Domiciliar , Serviços de Saúde Materna/normas , Cuidado Pós-Natal/métodos , Gravidez na Adolescência/psicologia , Adolescente , Análise de Variância , Depressão/diagnóstico , Depressão/psicologia , Feminino , Linhas Diretas/normas , Humanos , Cuidado Pós-Natal/normas , Gravidez , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários , Virginia
13.
Fam Community Health ; 39(2): 129-37, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26882416

RESUMO

Women who receive traumatic brain injuries (TBI) from intimate partner violence (IPV) are gaining attention; however, research studies are lacking in this area. A review of literature conducted on TBI from IPV found prevalence of 60% to 92% of abused women obtaining a TBI directly correlated with IPV. Adverse overlapping health outcomes are associated with both TBI and IPV. Genetic predisposition and epigenetic changes can occur after TBI and add increased vulnerability to receiving and inflicting a TBI. Health care providers and community health workers need awareness of the link between IPV/TBI to provide appropriate treatment and improve the health of women and families.


Assuntos
Mulheres Maltratadas/psicologia , Lesões Encefálicas/etiologia , Serviços de Saúde Comunitária/organização & administração , Violência por Parceiro Íntimo/psicologia , Adulto , Lesões Encefálicas/classificação , Lesões Encefálicas/diagnóstico , Feminino , Humanos , Prevalência , Prognóstico , Estados Unidos/epidemiologia
14.
Violence Against Women ; 22(8): 943-65, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26612275

RESUMO

This qualitative study of 10 rural women examines their lived experience of intimate partner violence during pregnancy and the first 2 postpartum years. In-depth interviews occurred during pregnancy and 4 times postpartum. A Heideggerian approach revealed "negotiating peril" as the overarching theme; sub-themes were unstable environment, adaptive calibration, primacy of motherhood, and numb acceptance. Some incremental shifts in severity of abusive situations were observed. Results elucidate the ambivalence with which these women view institutions that are designed to help them. Findings highlight factors that may explain why interventions designed to help often do not appear efficacious in facilitating complete termination of an abusive situation.


Assuntos
Adaptação Psicológica , Violência por Parceiro Íntimo/psicologia , Negociação/psicologia , Período Pós-Parto/psicologia , Gestantes , População Rural , Adolescente , Adulto , Feminino , Humanos , Masculino , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Pesquisa Qualitativa , Fatores de Risco , Meio Social , Adulto Jovem
15.
J Midwifery Womens Health ; 60(1): 48-55, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25597522

RESUMO

This article examines how the Frontier Nursing Service (FNS) utilized nurse-midwives to respond to antepartum emergencies such as preterm birth, eclampsia, malpresentation, and hemorrhage in the women of Appalachia in the years 1925 to 1939. Particular attention is given to the preparation that nurse-midwives received during their midwifery education to prevent and respond to emergencies. Using traditional historical research methods and primary source material from the FNS papers in the Special Collections, University of Kentucky Libraries, Lexington, Kentucky, this article describes the nurse-midwives' experiences and how they implemented skills they had learned during their training in Great Britain. Working in the isolated mountainous area of Leslie County, Kentucky-for the most part without direct assistance from physicians-FNS nurse-midwives decreased maternal and neonatal mortality rates. During their first 2000 births, they had only 2 maternal deaths, whereas the national average maternal mortality rate was approximately 7 deaths per 1000 births. The nurse-midwives performed external cephalic versions on a routine basis. For pregnancy and birth emergencies, they administered sedation, gave general anesthesia, and performed invasive lifesaving techniques in order to protect the lives of the women in their care. During these 14 years, their cross-cultural engagement, assessment skills, clinical judgment, and timely interventions improved maternal and child health throughout the region.


Assuntos
Emergências , Serviços Médicos de Emergência/história , Serviços de Saúde Materna/história , Tocologia/história , Enfermeiras Obstétricas/história , Complicações na Gravidez/história , Serviços de Saúde Rural/história , Feminino , História do Século XX , Humanos , Lactente , Mortalidade Infantil/história , Kentucky/epidemiologia , Morte Materna/história , Morte Materna/prevenção & controle , Mortalidade Materna/história , Enfermeiras Obstétricas/educação , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/terapia , População Rural
16.
Biol Res Nurs ; 17(3): 295-302, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25230746

RESUMO

A secondary pilot study was carried out as part of a larger parent study of thyroid function in pregnancy and postpartum. All women in the parent study (N = 631) had blood samples, demographic data, and measures of perceived stress and dysphoric moods collected between 16 and 26 weeks' gestation. The current study was completed with a subset of 105 pregnant women to examine the relationships among perceived stress, depression, plasma cortisol, and cytokines during the second trimester of pregnancy. Stress was measured using Cohen's Perceived Stress Scale and dysphoric moods using the Profile of Mood States Depression/Dejection Scale. Cytokines were measured by a 12-plex analysis on a Luminex-200, and cortisol was measured by enzyme-linked immunosorbent assay on stored plasma samples. Stress and depression scores were highly correlated, and depressive symptoms were inversely correlated with 3 of the 12 cytokines: interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, and IL-7. Cortisol was inversely correlated with proinflammatory cytokines (IL-1ß and TNF-α) and anti-inflammatory cytokines (IL-4, IL-5, IL-10, and IL-13). These data support the new conceptualizations of normal pregnancy as an inflammatory state that is carefully regulated, as both excessive and inadequate inflammation are potentially hazardous to the health of the pregnancy and fetus.


Assuntos
Citocinas/sangue , Depressão/sangue , Hidrocortisona/sangue , Complicações na Gravidez/sangue , Adulto , Depressão/psicologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interleucina-10/sangue , Interleucina-13/sangue , Interleucina-1beta/sangue , Interleucina-4/sangue , Interleucina-5/sangue , Interleucina-7/sangue , Fragmentos de Peptídeos/sangue , Projetos Piloto , Gravidez , Complicações na Gravidez/psicologia , Segundo Trimestre da Gravidez , Estresse Psicológico/sangue , Estresse Psicológico/psicologia , Fator de Necrose Tumoral alfa/sangue
17.
J Womens Health (Larchmt) ; 23(11): 920-6, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25290007

RESUMO

BACKGROUND: Intimate partner violence (IPV) affects an estimated 1.5 million U.S. women annually. IPV impacts maternal and neonatal health with higher rates of depression and low birth weight (LBW). Less studied is experiencing IPV and delivering a small for gestational age (SGA) baby. SGA neonates are at increased risk of developmental and behavioral problems. The negative sequelae persist into adulthood with increased rates of diabetes mellitus and coronary heart disease. METHODS: In a sample of 239 pregnant women experiencing IPV, in urban and rural settings, we examined cross-sectional associations of severity of IPV and neonatal outcomes (i.e., birth weight and gestational age). Severity of IPV was measured by the Conflict Tactics Scale 2 and neonatal outcomes were collected at the time of delivery. RESULTS: Outcomes were collected on 194 neonates; 14.9% (n=29) were classified as LBW, 19.1% (n=37) classified as SGA, and 9.8% (n=19) as LBW and SGA. Women reporting higher severity of IPV during pregnancy had a greater likelihood of delivering an SGA neonate (odds ratio [OR] 4.81; 95% confidence interval [95% CI] 1.86-12.47), and LBW neonate (OR 4.20; 95% CI 1.46-12.10). CONCLUSIONS: In a sample of pregnant women experiencing perinatal IPV, women experiencing greater severities of IPV were more likely to deliver a neonate with an adverse outcome. Early recognition and intervention of IPV is essential to reduce disparities in birth outcomes and long-term health outcomes for these neonates.


Assuntos
Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Pobreza/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Maus-Tratos Conjugais/estatística & dados numéricos , Adulto , Intervalos de Confiança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Razão de Chances , Gravidez , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
18.
Fam Community Health ; 37(3): 199-211, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24892860

RESUMO

In 1965, Nancy Milio established a prenatal and family planning clinic in Detroit, Michigan, to address health disparities and limited access to care among low-income, African American, urban women. Women's health disparities persist today nationally and internationally. Using historical methods, this research analyzes how Milio provided women's health services in the context of the social and political environment. Milio empowered neighborhood women to direct, plan, and participate in the care they received. Successful methods to address disparities in access to family and planning and prenatal care should include empowered participation from the women these programs are intending to serve.


Assuntos
Serviços de Planejamento Familiar/história , Disparidades em Assistência à Saúde , Enfermagem em Saúde Pública/métodos , Direitos Sexuais e Reprodutivos , Características de Residência , Adolescente , Adulto , Afro-Americanos , Criança , Pré-Escolar , Anticoncepcionais Orais/história , Feminino , Educação em Saúde , Promoção da Saúde/métodos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/normas , História do Século XX , Humanos , Centros de Saúde Materno-Infantil/organização & administração , Michigan , Áreas de Pobreza , Gravidez , Cuidado Pré-Natal/história , Direitos Sexuais e Reprodutivos/história , Condições Sociais , Serviços Urbanos de Saúde , População Urbana , Serviços de Saúde da Mulher/história , Adulto Jovem
19.
Med Hypotheses ; 82(6): 721-9, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24698849

RESUMO

Recent research challenges long-held hypotheses about mechanisms through which pregnancy induces maternal immune suppression or tolerance of the embryo/fetus. It is now understood that normal pregnancy engages the immune system and that the immune milieu changes with advancing gestation. We suggest that pregnancy mimics the innate immune system's response to stress, causing a sterile inflammatory response that is necessary for successful reproduction. The relationship between external stressors and immunomodulation in pregnancy has been acknowledged, but the specific mechanisms are still being explicated. Implantation and the first trimester are times of immune activation and intensive inflammation in the uterine environment. A period of immune quiescence during the second trimester allows for the growth and development of the maturing fetus. Labor is also an inflammatory event. The length of gestation and timing of parturition can be influenced by environmental stressors. These stressors affect pregnancy through neuroendocrine interaction with the immune system, specifically through the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-ovarian axis. Trophoblastic cells that constitute the maternal-fetal interface appear to harness the maternal immune system to promote and maximize the reproductive success of the mother and fetus. Pregnancy is a time of upregulated innate immune responses and decreased adaptive, cell-mediated responses. The inflammatory processes of pregnancy resemble an immune response to brief naturalistic stressors: there is a shift from T helper (Th) 1 to T helper (Th) 2 dominant adaptive immunity with a concomitant shift in cytokine production, decreased proliferation of T cells, and decreased cytotoxicity of natural killer (NK) cells. Inclusion of both murine and human studies, allows an exploration of insights into how trophoblasts influence the activity of the maternal innate immune system during gestation.


Assuntos
Implantação do Embrião/imunologia , Tolerância Imunológica/imunologia , Imunidade Inata/fisiologia , Gravidez/imunologia , Estresse Fisiológico/imunologia , Animais , Corpo Lúteo/imunologia , Feminino , Humanos , Imunidade Inata/imunologia , Camundongos , Placenta/imunologia , Linfócitos T Auxiliares-Indutores/imunologia
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