Paid- and family-carers' views on supporting women with intellectual disability through breast screening.

The cancer needs of people with intellectual disabilities are increasingly being debated. This paper explores the views and experiences of paid- and family-carers when supporting women with intellectual disabilities through breast screening. An ethnographic approach was drawn on and purposive sampling methods were employed. One-to-one semi-structured interviews with 13 carers (10 paid-carers, three family-carers) were undertaken and supported by periods of focused observation on behaviour related to breast awareness and breast screening. Findings indicated that most women with intellectual disabilities needed some support but the quality and quantity of support depended upon both the woman's level of intellectual disability and who was supporting them. In terms of breast screening, the findings suggested that the women were potentially being let down at all the different stages of the breast screening process, from the arrival of the invitation letter to the experience of having a mammogram. The conclusion drawn was that there was evidence of equality of service provision but inequality of service delivery and uptake.

Historical stocking data and 19th century DNA reveal human-induced changes to native diversity and distribution of cutthroat trout.

Many species are threatened with extinction and efforts are underway worldwide to restore imperilled species to their native ranges. Restoration requires knowledge of species' historical diversity and distribution. For some species, many populations were extirpated or individuals moved beyond their native range before native diversity and distribution were documented, resulting in a lack of accurate information for establishing restoration goals. Moreover, traditional taxonomic assessments often failed to accurately capture phylogenetic diversity. We illustrate a general approach for estimating regional native diversity and distribution for cutthroat trout in the Southern Rocky Mountains. We assembled a large archive of historical records documenting human-mediated change in the distribution of cutthroat trout (Oncorhynchus clarkii) and combined these data with phylogenetic analysis of 19th century samples from museums collected prior to trout stocking activities and contemporary DNA samples. Our study of the trout in the Southern Rocky Mountains uncovered six divergent lineages, two of which went extinct, probably in the early 20th century. A third lineage, previously declared extinct, was discovered surviving in a single stream outside of its native range. Comparison of the historical and modern distributions with stocking records revealed that the current distribution of trout largely reflects intensive stocking early in the late 19th and early 20th century from two phylogenetically and geographically distinct sources. Our documentation of recent extinctions, undescribed lineages, errors in taxonomy and dramatic range changes induced by human movement of fish underscores the importance of the historical record when developing and implementing conservation plans for threatened and endangered species.

Plasma cortisol and neuropeptide Y in female victims of intimate partner violence.

BACKGROUND: The experience of intimate partner violence (physical and sexual violence) has been linked to psychiatric disorders such as posttraumatic stress disorder, yet data on the neuroendocrine profile in this population is sparse. This study sought to examine baseline plasma cortisol and neuropeptide Y (NPY) levels in female victims of intimate partner violence (IPV). METHODS: Morning plasma samples were collected for cortisol and NPY determination in 22 women with histories of IPV (10 with current PTSD, 12 without current or lifetime PTSD) and 16 non-abused controls. RESULTS: Mean cortisol levels were significantly lower in IPV subjects compared with controls, but did not distinguish IPV subjects with and without PTSD. There were no significant differences in mean NPY levels between the groups. Neither cortisol nor NPY levels were significantly correlated with PTSD symptoms. CONCLUSIONS: These preliminary findings suggest that victims of IPV, like women traumatized by childhood abuse, may be characterized by alterations in hypothalamic-pituitary-adrenal axis functioning, however, further study is needed to identify specific stress system disturbances in this group.

Vitamin A and HIV infection: disease progression, mortality, and transmission.

Among HIV-infected individuals, many nutritional factors that influence disease progress, mortality, and transmission are not well understood. Of particular interest is the role of vitamin A. The benefits of vitamin A have been recognized since ancient times by Egyptian physicians who successfully treated night blindness with vitamin A. Contemporary scientists have since recognized the importance of vitamin A and have provided evidence that it may help in repairing damaged mucosal surfaces; what remains unclear, however, is its role during HIV infection. In this review, we examine the evidence provided in both observational studies and randomized controlled trials that assessed the effect of vitamin A during HIV infection.

Antenatal diagnosis of vesicouterine fistula.

BACKGROUND: In pregnancy, vesicouterine fistulas usually are diagnosed postpartum after cesarean deliveries. CASE: An 18-year-old woman, gravida 3, para 2, with two prior cesarean deliveries had pain and apparent rupture of membranes at 23 weeks' gestation. At 26 weeks' gestation, she developed increasing suprapubic pain and irregular contractions. Ultrasonographic findings included a small uterine defect and possible ballooning of membranes into her bladder. Cytoscopy showed ballooning of amnion into the bladder dome. A viable 900-g female infant was delivered by classic cesarean, the fistulous tract was excised, and the rupture sites were repaired. CONCLUSION: Vesicouterine fistulas might be diagnosed antenatally. With continued contractions and associated uterine rupture, cesarean delivery can be done with excision of the fistulous tract and repair of the rupture sites.

Risk of repetition of a severe perineal laceration.

OBJECTIVE: To compare the outcome of subsequent delivery in women with a history of a third- or fourth-degree laceration with outcomes in women without such a history. METHODS: This retrospective study used a perinatal database and chart review from 1978 to 1995. Only women whose first delivery was at our institution at more than 36 weeks' gestation, vaginal singleton, vertex presentation, and birth weight greater than 2500 g, with a subsequent delivery were included. The women were grouped by presence or absence of a third- or fourth-degree (severe) perineal laceration in their first delivery. The subsequent delivery was analyzed for maternal age, weight, birth weight, gestational age, method of delivery, use of episiotomy, and occurrence of a severe laceration. Comparison of data was by Fisher exact and t tests. RESULTS: Four thousand fifteen women met our starting criteria. In their first delivery, the average birth weight, use of instrumentation, and episiotomy rate were significantly higher in those women sustaining a severe laceration. When compared with women without a history of severe perineal laceration, women with such a history were at more than twice the risk for another in their subsequent delivery. The women at highest risk (21.4%) were those sustaining a laceration in their first delivery who underwent instrumental vaginal delivery with episiotomy in their subsequent delivery. When episiotomy or instrumental delivery was performed in the second vaginal birth, 52 (11.6%) of 449 women with a history of a severe perineal laceration sustained another, compared with 98 (6.5%) of 1509 without such a history (P < .001, odds ratio 1.9, 95% confidence interval 1.3, 2.7). CONCLUSION: Women delivering their second baby, and in whom episiotomy or instrumentation is used, are at increased risk of severe perineal laceration compared with women delivery spontaneously.

Cognitive difficulties and posttraumatic stress disorder in female victims of intimate partner violence.

Subjective cognitive complaints of women exposed to intimate partner violence (IPV) and nonabused women were examined using the Cognitive Difficulties Scale (CDS). Cognitive complaints were compared among victims of IPV with a lifetime diagnosis of posttraumatic stress disorder (PTSD) (PTSD+; n=20), victims of IPV without lifetime PTSD (PTSD-; n=21), and a nonabused comparison group (n=22). The results indicated that both the PTSD+ and PTSD- groups had significantly higher levels of self-perceived cognitive difficulties than nonabused women. Furthermore, PTSD symptom severity was found to be positively correlated with self-perceived cognitive difficulties (r=.47). Further research is needed to determine whether cognitive complaints are associated with exposure to IPV, with the subsequent development of PTSD, or with other not yet understood factors. Furthermore, additional work is needed to resolve whether cognitive complaints are accompanied by objective evidence of cognitive dysfunction in victims of IPV.

Childhood nutrition.

This review focuses on the research in normative nutrition for children aged 2 to 12, published from 1985 to 1996. The chapter uses a primary prevention framework and the Healthy People 2000 (Public Health Service, 1990) objectives to identify and review those areas relevant for childhood health promotion and nursing practice. Current research demonstrates that food intake in early childhood is causally linked to health-related problems later in life, therefore obesity and cardiovascular research are highlighted in this review. Environmental and societal factors affect the nutritional health of children, thus the contribution of the media, poverty, cultural, and family practices are also reviewed. The chapter concludes with a summary of strengths and weaknesses of the body of research and suggestions for a nursing agenda in the area of childhood nutrition.

Risk taking in young Hispanic children.

INTRODUCTION: The purpose of this study was to examine risk taking and daring behavior in preschool-age Hispanic children. The study sought to describe aspects of children's personality, behavior, and culture that may inform us of their propensity to take risks that lead to injuries. METHOD: Forty-five children (4 to 5 years of age) and their parents, drawn from a primary care practice, participated in the study. Instruments completed by the families included the Acculturation Scale. Child Shyness Report, Injury Report, and the Injury Behavior Checklist. Children were interviewed about risk taking and daring behavior using a projective technique (Child Sensation Seeking Profile). RESULTS: These children, irrespective of gender and socioeconomic status, reported similar rates of daring and risk taking behavior. Injury behaviors were not predicted by personality profiles of shyness or the child's self-report of risk taking and daring behavior. Actual injuries increased with higher levels of acculturation, but children's injury behaviors reported by parents were low in comparison with other populations. Discrepancies were observed between parental perception and report of children's injury behavior and children's expressed preferences in some domains of daring and risky behavior. DISCUSSION: Primary care providers must consider ethnic differences in rates and causes of injury when developing interventions and injury prevention programs. PNPs can use these findings to better meet the health promotion goals of Healthy Children 2000.

Are children's early emotions antecedents to risk taking?

PURPOSE: To explore the processes by which early emotional experiences affect behavior and to investigate the use of basic development characteristics to guide primary care. METHOD: A randomized cohort of 74 children from a wide range of socio-economic classes were followed from infancy until 54 months of age. Children were assessed at 2 days, 12, 18 and 54 months by laboratory tests and maternal report. RESULTS: The personality characteristic of inhibition/shyness appeared to be an enduring trait from infancy through the preschool years. However, findings did not support the view that early personality variables (e.g., avidity, shyness, security) alone predict risk taking during later years. CONCLUSIONS: Nurses offering safety counseling about risk taking in order to minimize injuries during early childhood should consider personality concepts to be multi-dimensional. Infant and toddler profiles should not be considered solely predictive of later behavior.

Television and young Hispanic children's health behaviors.

Television viewing patterns in preschool age Hispanic children were studied in order to explore the role of TV in the establishment of early childhood health behaviors. The television viewing habits and patterns of children and parents and parental coviewing, regulation, and encouragement practices were examined. Using the dimensions of regulation and encouragement, four parental typologies were established: laissez-faire, restrictive, promotive, and selective. Children in this study watched television 3-4 hours a day, half of which consisted of viewing adult shows. This amount of time is significantly higher than the guideline of less than 2 hours a day suggested by the American Academy of Pediatrics (AAP). Relationships between television viewing, injury behaviors, risk taking, and acculturation were established and implications for primary care, school, and community health care nursing are discussed.

Experience in the design and use of isolator systems for sterility testing.

The use of isolator systems for sterility testing is on the increase. Prior to installation and validation careful consideration must be given to the type of barrier to be used, and the design of the facility which will house the barrier system. The validation of these systems requires development and testing of the sterilization cycle. Vapor phase hydrogen peroxide has proven to be efficacious in this application, and examples of sterilization cycle development are presented in this paper. Also of concern is the penetration of sterilant into test articles, media and supplies.

Pandemic H1N1 (2009) and renal failure: the experience of the Irish national tertiary referral centre.

INTRODUCTION: H1N1 influenza A, was first described in April 2009. A significant cohort of patients from this outbreak developed acute respiratory distress syndrome or pneumonia. H1N1 has since been transmitted across the world. Little has been described on the renal complications of this illness. METHODS: A retrospective review of all patients admitted to our institution with H1N1 infection was carried out from July to November 2009. Renal biochemistry, need for renal replacement therapy and hospital outcome was recorded. RESULTS: Thirty-four patients with H1N1 were admitted. Average length of admission was 10 days (3-84). Eleven patients (32%) developed acute kidney injury (AKI) as defined by the RIFLE criteria (creatinine range 120-610). Four patients required renal replacement therapy, for a range of 10-52 days. Seven patients developed AKI that responded to volume resuscitation. The commonest cause of AKI was sepsis with acute tubular necrosis. CONCLUSION: This study highlights the significance and frequency of renal complications associated with this illness.

Meta analysis: effects of interventions on premature infants feeding.

Nipple feeding of premature infants presents a challenge to neonatal nurses who are trying to prepare the infants for eventual discharge from the hospital. To determine what empirical evidence there was to support interventions that positively influence feeding performance and feeding efficiency a meta-analysis is presented. The effects of NPO, nasogastric tubes, different nipples, breast versus bottle feeding, gestational age, oral support, oral stimulation, and nonnutritive sucking on volume intake are evaluated. The results suggest that nursing care should: (a) consider the infant's gestational age; (b) maturational ability and development; (c) keep track of and attempt to minimize the length of time an infant is NPO; and (d) provide prefeeding oral stimulation and oral support.

The influence of the timing of preparation on the anxiety of preschool children experiencing surgery.

A quasi-experimental design with two groups of preschool children was used to determine if surgical preparation offered at two different time periods would result in different levels of state anxiety and posthospital behavioral upset. Twenty-three children (3 to 6 years of age) were studied. The children in one group were prepared the afternoon before surgery, and the children in the other group were prepared the morning of surgery. The same surgical preparation program was given to all the children by the principal investigator. The state anxiety level of each child was assessed at six time points during the ambulatory surgical experience. The posthospital behavioral upset of each child was also measured. The parent of each child responded to a 27-item questionnaire one week after discharge. Analysis of the observation and questionnaire data indicated that the children who were prepared the afternoon before surgery did not differ significantly in state anxiety or posthospital behavioral upset from the children who were prepared the morning of surgery. Also, the levels of anxiety of the children in the two preparation groups did not vary significantly with the type of surgery. The state anxiety mean score of the children in the morning preparation group at each time point was lower than the mean score of the children in the afternoon preparation group at each time point. Replication of the study with a larger sample size is recommended.

Risk-taking in preschool children.

This study was designed to characterize preschool-age children who engage in daring, risk-taking behaviors. Seventy-four children (39 males, 35 females) and their mothers from a wide range of socioeconomic strata participated. Children who described themselves as high in risk-taking were generally males, had higher accident and injury rates, and had parents whose assessments of their children's risk-taking activities were congruent with their own. Contrary to our expectations, however, risk-taking children did not appear to be more than ordinarily impulsive, which suggests that risk-taking is engaged in contemplatively (i.e., with some caution) by some youngsters and need not result in serious mishaps. Cognitive ability was found to be a codependent predictor of risk-taking for boys. Parents and clinicians will find it useful to know that risk-taking is a multidimensional phenomenon, not a unitary behavior or personality trait and that the Injury Behavior Checklist would be a valuable tool for screening selected populations.

Technetium carboxylate complexes--III. A new synthetic route to hexakis-(isonitrile) technetium(I) salts.

Hexakis(isonitrile)technetium(I) cations have been prepared from carboxylate based technetium starting materials. The following ligands have been employed: t-butyl, n-butyl, cyclohexyl, and benzyl isonitrile. The products have been characterized by u.v.-visible and i.r. spectroscopy, cyclic voltammetry, fast atom bombardment mass spectrometry and electrophoresis.

Technetium carboxylate complexes--II. Structural and chemical studies.

Formate, acetate, and pivalate based complexes of technetium have been prepared by the electrochemical reduction of pertechnetate in the appropriate carboxylate buffer. Also, chemical synthetic routes to these complexes have been explored using technetium chloro compounds of known oxidation states as starting materials. The technetium carboxylate complexes were selectively examined by subtractively normalized interfacial Fourier transform infrared, electron spin resonance, and electronic spectroscopy, electrochemistry, electrophoresis, and anion exchange chromatography. These complexes have been proposed to be metal-metal bonded dioxo bridged ditechnetium(IV) species with axial and bridged carboxylate ligands.

Intrauterine growth restriction: identification and management.

Intrauterine growth restriction (IUGR) is a common diagnosis in obstetrics and carries an increased risk of perinatal mortality and morbidity. Identification of IUGR is crucial because proper evaluation and management can result in a favorable outcome. Certain pregnancies are at high risk for growth restriction, although a substantial percentage of cases occur in the general obstetric population. Accurate dating early in pregnancy is essential for a diagnosis of IUGR. Ultrasound biometry is the gold standard for assessment of fetal size and the amount of amniotic fluid. Growth restriction is classified as symmetric and asymmetric. A lag in fundal height of 4 cm or more suggests IUGR. Serial ultrasonograms are important for monitoring growth restriction, and management must be individualized. General management measures include treatment of maternal disease, good nutrition and institution of bed rest. Preterm delivery is indicated if the fetus shows evidence of abnormal function on biophysical profile testing. The fetus should be monitored continuously during labor to minimize fetal hypoxia.