Meta-Analyses of Predictors of Health Practices in Pregnant Women.

The aims of this study were to identify predictors of health practices of pregnant women in the literature reviewed, to use meta-analysis to ascertain the mean effect size (ES) across studies between each predictor and health practices, and to examine four moderators on each predictor-health practices relationship. Using preferred reporting items for systematic reviews and meta-analyses guidelines for the literature assessed, 32 published studies or doctoral dissertations completed between 1992 and 2015 met the inclusion criteria. Twelve predictors were identified, and each predictor in relation to health practices was subjected to meta-analysis. One predictor (maternal-fetal attachment) of health practices had a large ES, two predictors (depression and stress) had medium ESs, six predictors (income, education, parity, social support, employment, and age) had small ESs, and three predictors (gestational age, marital status, and race) had trivial ESs. Findings are interpreted relative to health practices in pregnant women.

Factors Related to Intimidation During Oxytocin Administration.

Patient's safety and quality are foremost issues in healthcare today and are often adversely influenced by communication and issues of perceived intimidation. Labor and delivery nurses are responsible for managing oxytocin infusions, but disagreements between providers and nurses related to the administration have been shown to cause tension and affect patient's care. The purpose of this study was to survey registered nurses in labor and delivery about perceived intimidation and how intimidation influenced actions and decisions. A total of 913 registered nurses who were members of the Association of Women's Health, Obstetric, and Neonatal Nurses and identified labor and delivery comprised the sample as their clinical focus. Nurses who met the inclusion criteria were invited to participate in the survey via e-mail invitation. An online survey assessing workplace intimidation by providers while managing oxytocin inductions, as well as demographic information was completed. Participants reported past issues with intimidation that influenced how they administered oxytocin. Nurses reported that past experiences with intimidation influenced their care and that they had been involved with medication errors where intimidation played a role. Organizational factors perceived supportive management, presence of an organizational code of conduct, and environment where collaboration was encouraged were associated with decreased reports of intimidation.

HINT1 peptide/Hsp70 complex induces NK-cell-dependent immunoregulation in a model of autoimmune demyelination.

Heat shock proteins (Hsps) interact with the immune system and have been shown to contribute to immunoregulation. As efficient chaperones, Hsps bind many peptides and these complexes have many yet-to-be-clarified functions. We have shown that Hsp70 is complexed within the mouse CNS with peptide CLAFHDISPQAPTHFLVIPK derived from histidine triad nucleotide-binding protein-1 (HINT138₋57/Hsp70). Only this complex, in contrast to other peptides complexed with Hsp70, was able to prevent experimental autoimmune encephalomyelitis (EAE) by induction of immunoregulatory mechanisms dependent on NK cells. Pretreatment of proteolipid protein peptide 139₋151(PLP139₋151) sensitized SJL/J mice with HINT138₋57/Hsp70 prevented the development of EAE, suppressed PLP139₋151-induced T-cell proliferation, and blocked secretion of IL-17. HINT138₋57 /Hsp70 stimulation of NK cells depended on synergistic activation of two NK-cell receptors, CD94 and NKG2D. NK cells with depleted CD94 or with blocked NKG2D did not inhibit PLP139₋151-induced spleen cell (SC) proliferation. The HINT138₋57/Hsp70 complex enhanced surface expression of the NKG2D ligand-H60. Downstream signaling of CD94 and NKG2D converged at the adaptor proteins DAP10 and DAP12, and in response to HINT138₋57 /Hsp70 stimulation, expression of DAP10 and DAP12 was significantly increased in NK cells. Thus, we have shown that the HINT138₋57 /Hsp70 complex affects NK-cell function by enhancing NK-cell-dependent immunoregulation in the EAE model of autoimmune demyelination.

Psychometric Properties of the Survey of Workplace Intimidation Instrument.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the psychometric properties of the Survey of Workplace Intimidation (SWI), including content and construct validity, factor structure, and internal consistency. METHODS: A cross-sectional, descriptive study design was used for this study. The final sample consisted of 237 labor and delivery nurses who completed the SWI and the Practice Environment Scale of the Nursing Work Index (PES-NWI). Cronbach's alpha for the SWI was .930. RESULTS: Content validity was obtained and the scale content validity index (S-CVI) was .943. Convergent validity was calculated by comparing the SWI with the PES-NWI, and the result was .408 (p = .01). A factor analysis explained 61% of the variance and resulted in two factors: prescriber behaviors and nurses' responses to prescribers' behaviors. CONCLUSIONS: The SWI demonstrated acceptable reliability and validity.

Faculty perception of bullying in schools of nursing.

This article is a report of a study conducted to determine the prevalence of bullying among faculty members in schools or colleges of nursing. The issue of bullying of nursing faculty in the academic setting is of interest in terms of recruitment, retention, job satisfaction, and the overall quality of the work environment. This cross-sectional, descriptive study of faculty in three northeastern states of the United States was carried out in 2010. The Negative Acts Questionnaire-Revised (NAQ-R) was used to survey faculty members in schools of nursing who award a baccalaureate degree (or higher) in nursing. A total of 473 faculty members met the inclusion criteria and responded to the NAQ-R. An iterative exploratory principal components analysis with orthogonal rotation was performed. Of the original 22 items, 13 were retained to measure the experiences of negative acts in the nursing faculty workplaces. The mean total score for the 13-item instrument was 17.90 (SD = 6.07) and ranged from 13 to 56. The resulting components structure produced three clear subscales identifying the experiences of verbal abuse, physical abuse, and devaluing. The revised 13-item instrument had a Cronbach's alpha value of .88. Experiences of bullying were reported in 169 of the 473 (36%) respondents. A significant correlation was found between meeting frequency and the report of bullying (r = .18, P ≤ .001). Administrators and senior faculty were more likely than expected to be the perpetrators of bullying. If the leaders are identified as bullies, the environment cannot be perceived as supportive and healthy. These unhealthy environments may have serious consequences related to retaining nursing faculty.

Preoperative screening/decolonization for Staphylococcus aureus to prevent orthopedic surgical site infection: prospective cohort study with 2-year follow-up.

We quantified surgical site infections (SSIs) after preoperative screening/selective decolonization before elective total joint arthroplasty (TJA) with 2-year follow-up and 2 controls. Concurrent controls (n = 2284) were patients of surgeons not participating in screening/decolonization. Preintervention controls (n = 741) were patients of participating surgeons who underwent TJA the previous year. Staphylococcus aureus nasal carriers (321/1285 [25%]) used intranasal mupirocin and chlorhexidine baths as outpatients. Staphylococcal SSIs occurred in no intervention patients (0/321) and 19 concurrent controls. If all SSIs occurred in carriers and 25% of controls were carriers, staphylococcal SSI rate would have been 3.3% in controls (19/571; P = .001). Overall SSI rate decreased from 2.7% (20/741) in preintervention controls to 1.2% (17/1440) in intervention patients (P = .009). Preoperative screening/selective decolonization was associated with fewer SSIs after elective TJA.

A meta-analytic study of predictors of maternal-fetal attachment.

OBJECTIVES: To identify predictors of maternal-fetal attachment (MFA) through a comprehensive review of the literature, and to use quantitative meta-analysis to determine the magnitude of the relationship between each predictor and MFA. DESIGN: The literature reviewed included 183 studies of MFA, published and unpublished, between 1981 and 2006. METHODS: Seventy-two studies met the inclusion criteria and yielded 14 predictors of MFA. A meta-analysis was performed on each of the 14 predictors in relation to MFA. RESULTS: The results indicated that gestational age had a moderate to substantial effect size. Two predictors (social support and prenatal testing) had moderate effect sizes; 10 predictors (anxiety, self-esteem, depression, planned pregnancy, age, parity, ethnicity, marital status, income, and education) had low effect sizes. High-risk pregnancy had a trivial effect size. CONCLUSIONS: The most powerful predictors of MFA using meta-analysis were identified to direct future research and evidence-based practice.

Effects of hyperglycemia on rat cavernous nerve axons: a functional and ultrastructural study.

The present study explored parallel changes in the physiology and structure of myelinated (Adelta) and unmyelinated (C) small diameter axons in the cavernous nerve of rats associated with streptozotocin-induced hyperglycemia. Damage to these axons is thought to play a key role in diabetic autonomic neuropathy and erectile dysfunction, but their pathophysiology has been poorly studied. Velocities in slow conducting fibers were measured by applying multiple unit procedures; histopathology was evaluated with both light and electron microscopy. To our knowledge, these are the initial studies of slow nerve conduction velocities in the distal segments of the cavernous nerve. We report that hyperglycemia is associated with a substantial reduction in the amplitude of the slow conducting response, as well as a slowing of velocities within this very slow range (< 2.5 m/s). Even with prolonged hyperglycemia (> 4 months), histopathological abnormalities were mild and limited to the distal segments of the cavernous nerve. Structural findings included dystrophic changes in nerve terminals, abnormal accumulations of glycogen granules in unmyelinated and preterminal axons, and necrosis of scattered smooth muscle fibers. The onset of slowing of velocity in the distal cavernous nerve occurred subsequent to slowing in somatic nerves in the same rats. The functional changes in the cavernous nerve anticipated and exceeded the axonal degeneration detected by morphology. The physiologic techniques outlined in these studies are feasible in most electrophysiologic laboratories and could substantially enhance our sensitivity to the onset and progression of small fiber diabetic neuropathy.

Amelioration of experimental autoimmune encephalomyelitis in IL-4Ralpha-/- mice implicates compensatory up-regulation of Th2-type cytokines.

The cytokine receptor interleukin (IL)-4R, expressed by lymphocytes, is well known for its role in immunomodulatory signaling and has also been documented on oligodendrocytes, suggesting involvement in glial cell interactions. In the present study, we investigated the clinical course and pathology of experimental autoimmune encephalomyelitis in mice demonstrating deletion of IL-4R and found a correlation with cytokine expression during acute and chronic disease. Wild-type (WT) littermates served as controls. Although IL-4R(-/-) mice displayed a milder course throughout, they showed comparable pathology to WT in the acute phase. However, during the chronic phase, IL-4R(-/-) mice exhibited extensive remyelination and an apparent increase in oligodendrocytes. Cytokine patterns were examined by immunocytochemistry, fluorescence-activated cell sorting, and enzyme-linked immunosorbent assay and were strongly proinflammatory within the central nervous system during the acute phase in WT mice whereas IL-4R(-/-) animals expressed higher levels of IL-6 and IL-10 that became more pronounced with time. The milder experimental autoimmune encephalomyelitis and enhanced remyelination in IL-4R(-/-) mice appeared to be related to a shift toward a Th-2 pattern involving mainly IL-6 and IL-10. These data suggest that IL-4R exerts a negative regulatory role on oligodendrocytes that when deleted results in enhanced myelin repair.

A preoperative decolonization protocol for staphylococcus aureus prevents orthopaedic infections.

UNLABELLED: Staphylococcus aureus (S. aureus) is an independent risk factor for orthopaedic surgical site infection (SSI). To determine whether a preoperative decolonization protocol reduces S. aureus SSIs, we conducted a prospective observational study of patients undergoing elective total joint arthroplasty (TJA) at our institution, with two control groups. The concurrent control group comprised patients of surgeons who did not participate in the intervention study. The preintervention control group comprised patients of participating surgeons who had undergone elective TJA during the year before the study. Patients in the intervention group were screened preoperatively for S. aureus by nasal swab cultures. S. aureus carriers were decolonized with mupirocin ointment to the nares twice daily and chlorhexidine bath once daily for 5 days before surgery. All 164 of 636 participants (26%) who tested positive completed the decolonization protocol without adverse events and had no postoperative S. aureus SSIs at 1-year followup. In contrast, 1330 concurrent control patients had 12 S. aureus infections. If these infections had occurred in the 26% of patients expected to be nasal carriers of S. aureus at a given time, the infection rate would have been 3.5% (12 of 345) in the control group. In addition, the overall infection rate of the participating surgeons, including nonstaphylococcal infections, decreased from 2.6% during the preintervention period to 1.5% during the intervention period, translating to an adjusted economic gain of $231,741 for the hospital. The data suggest a preoperative decolonization protocol reduces S. aureus SSIs in patients undergoing TJA. LEVEL OF EVIDENCE: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Multiple sclerosis: death receptor expression and oligodendrocyte apoptosis in established lesions.

To determine whether TNF and TRAIL death receptors (DR), and decoy receptors (DcR), play a role in oligodendrocyte depletion in the lesions of chronic multiple sclerosis (MS), we investigated the presence and functionality of these molecules on oligodendrocytes in MS and non-MS brain tissue and on human oligodendrocytes in vitro. For this, we performed immunocytochemistry, Western blotting, TUNEL and FACS analysis for the presence of DR and apoptosis in sections of fresh frozen CNS tissue from cases of chronic MS, other neurologic diseases and normals, and in fetal human oligodendrocytes in vitro. The results showed that although oligodendrocytes demonstrated both DR and DcR, particularly in vitro, there was no predilection of the phenomenon for MS and apoptosis of oligodendrocytes, common in cultures after ligation with TRAIL, was negligible in CNS tissue in situ. Thus, death of oligodendrocytes by apoptosis was an infrequent event in all human CNS samples examined. We postulate that while oligodendrocyte apoptosis might prevail during the initial stages of MS, from our findings other mechanisms probably account for their loss in the established lesion and decoy receptors may play a protective role in oligodendrocyte survival.

Structural and functional investigations of the murine cavernosal nerve: a model system for serial spatio-temporal study of autonomic neuropathy.

OBJECTIVE: To illustrate the ultrastructural fibre composition of the rat cavernosal nerve at serial levels, from its origin in the main pelvic ganglion to its termination in the corpus cavernosum of the distal penile shaft, and to develop a technique that permits repeated electrophysiological recording from the fibres that form the cavernosal nerve distinct from the axons of the dorsal nerve of the penis (DNP). MATERIALS AND METHODS: For the light microscope and ultrastructural studies, Sprague-Dawley rats were anaesthetized and the pelvic organs and lower limbs were perfused with glutaraldehyde through the distal aorta. Tissue samples were embedded in epoxy resin and prepared for light and electron microscopy. Frozen tissue was used for the immunohistochemical studies and sections were stained with rabbit anti-nitric oxide synthetase 1 (NOS1). For the electrophysiology, anaesthetized rats were used in sterile conditions. Nerve conduction velocity for the cavernosal nerve was assessed from a point 2 mm below the main (major) pelvic ganglion after stimulating the nerve at the crus penis; multi-unit averaging techniques were used to enhance the recording of slow-conduction activity. Recordings from the DNP were obtained over the proximal shaft after stimulation at the base of the penis. RESULTS: Step-serial sections of the cavernosal nerve revealed numerous ganglion cells in the initial segments and gradually fewer myelinated fibres at distal levels. At the point of crural entry, the nerve contained almost exclusively unmyelinated axons. As it descended the penile shaft, the nerve separated into small fascicles containing only one to four axons at the level of the distal shaft. In the corpus cavernosum, vesicle-filled presynaptic axon preterminals were close to smooth muscle fibres, but did not seem to be in direct contact. Immunohistochemical evaluation of NOS1 activity showed intense staining of the fibres of the DNP and most of the neurones in the main pelvic ganglion. There was also scattered NOS1 activity in the nerve bundles of the corpus cavernosum. Electrophysiology identified activity in C fibres on the cavernosal nerve and in Aalpha-Adelta fibres in the DNP. CONCLUSION: These results show that it is possible to perform integrated cavernosal pressure monitoring and ultrastructural and electrophysiological studies in this model. These yielded accurate data about the erectile status of the penis, and the state of unmyelinated and myelinated fibres in the DNP and cavernosal nerves of the same animal. This study provides a useful template for future studies of experimental diabetic autonomic neuropathy.

Mediators of the relationship between social support and positive health practices in pregnant women.

BACKGROUND: Literature suggests that there is a need to study a broadly conceived variable of positive health practices in pregnant women and to examine theoretically related variables that help to explain positive health practices in pregnant women. OBJECTIVES: The aims of this study were to examine the association between social support and positive health practices in pregnant women and to further test this relationship by examining two mediational variables: perceived health status and optimism. METHOD: A convenience sample of 152 pregnant women attending childbirth education classes completed the four study instruments and a demographic data sheet. RESULTS: Social support was related positively to positive health practices; this relationship was basic to both mediational models. In the first mediational model, social support was related positively to perceived health status, and perceived health status was related positively to positive health practices, but perceived health status was not a complete mediator of the social support-positive health practices relationship, as determined by regression analyses. In the second mediational model, social support was related positively to optimism, and optimism was related positively to positive health practices, but optimism was not a complete mediator of the social support-positive health practices relationship, as determined by regression analyses. DISCUSSION: Positive health practices in pregnant women are related positively to social support, perceived health status, and optimism. In terms of theory building, neither perceived health status nor optimism help to explain the social support-positive health practices relationship. Replication of this study with a more diverse sample is one recommendation for future study.

A meta-analytic study of predictors for loneliness during adolescence.

BACKGROUND: Extensive research has been completed to investigate loneliness in adolescents over the past several decades; identification of key predictors for loneliness was needed using meta-analytic techniques. OBJECTIVES: To identify predictors for loneliness in adolescents through a comprehensive review of the literature and to use quantitative meta-analysis to determine the magnitude of the relationships between each predictor and loneliness. METHODS: The literature reviewed included 242 studies published or unpublished between 1980 and 2004, of which 95 met the inclusion criteria. Eleven key predictors for loneliness were identified in the 95 studies. A meta-analysis was conducted on each of the 11 predictors in relation to loneliness. RESULTS: Four predictors (gender, depression, shyness, and self-esteem) had large effect sizes, four predictors (social support, social anxiety, maternal expressiveness, and paternal expressiveness) had large medium to medium effect sizes, two predictors (stress and self-disclosure) had low effect sizes, and one predictor (age) had a very low effect size. DISCUSSION: Theories of loneliness served as a framework for interpreting the findings of the meta-analysis. The most powerful predictors can be used in intervention studies aimed at reducing loneliness in adolescents.

Maternal-fetal attachment: an integrative review.

AIMS: This paper presents an integrative review of the literature that aimed to (a) review, categorize and critique the published research on maternal-fetal attachment (MFA), (b) analyse and interpret the MFA findings and (c) evaluate the state of knowledge on MFA and provide directions for future research. BACKGROUND: Previous researchers have examined MFA in independent studies using a variety of research designs. There was a need to synthesize the findings across studies in order to evaluate the knowledge developed about MFA since the construct was created. METHODS: Five stages for conducting an integrative review were carried out. The research problem was identified; data were collected; data were evaluated; findings were analysed and interpreted. Forty-one studies of MFA were located using the online databases of Medline, International Nursing Index, Cumulative Index of Nursing and Allied Health Literature, and Psychological Information. The keywords for the search were MFA, parental-fetal attachment, and prenatal attachment. FINDINGS: Of the 41 studies reviewed, there were 152 findings relevant to the analysis. Of the 152 findings, 70 were statistically significant, while 82 were not. CONCLUSIONS: Research focusing on MFA has begun to create a body of scientific knowledge. This needs to be expanded through continued research using a variety of designs.

Comparison of children's fears of medical experiences across two cultures.

INTRODUCTION: This study examined the self-reported fears of school-age children living in the United States and in Nepal. METHOD: Thirty school-age children from each country, matched by sex and age, participated in this study. The revised version of the Child Medical Fear Scale was used to identify medical fears of children. RESULTS: Among 17 feared items, the result showed getting a shot to be the most feared item reported by both groups. Nepalese children reported higher fear scores than did American children. It also was found that there was a significant difference in fear scores between Nepalese boys and girls, with girls reporting higher fear scores than boys. There was no difference in fear scores between American boys and girls. DISCUSSION: The findings of this study are important to nurse practitioners in understanding children's fears of medical experiences across different cultures. Nurses can support children in dealing with their fears of medical experiences by recognizing these fears and taking into consideration the child's family, sex, and culture when planning care. Nursing implications are discussed.

A meta-analysis of predictors of positive health practices.

PURPOSE: To identify predictors of positive health practices from empirical studies in which the Personal Lifestyle Questionnaire was used. METHODS: Meta-analysis to determine the magnitude of the relationships between each of the predictors identified and positive health practices. Fourteen predictors of positive health practices were identified in 37 studies published since 1983; a meta-analysis was conducted on 14 predictors. RESULTS: Eight predictors (loneliness, social support, perceived health status, self-efficacy, future time perspective, self-esteem, hope, and depression) had moderate effect sizes, and six (stress, education, marital status, age, income, and sex) had small effect sizes. CONCLUSIONS: Findings enable health care professionals and researchers designing intervention studies to use the strongest predictors identified in this meta-analysis to promote positive health practices.

Multiple sclerosis: cytokine receptors on oligodendrocytes predict innate regulation.

Multiple sclerosis (MS) is an immune-mediated demyelinating condition in which numerous soluble mediators have been implicated. We have extended the repertoire of cytokines studied in MS tissue by examining interleukin (IL-4), IL-6, IL-10, IL-12, IL-18, interferon (IFNgamma), and their receptors and have compared patterns with those seen in normal subjects and other neurological diseases (OND). Expression was evaluated by immunocytochemistry and Western blots. Remarkably, oligodendrocytes expressed all the cytokine receptors examined, particularly Th2-type, constitutively in normal subjects and upregulated in disease. Microglial cells also expressed cytokine receptors at similar levels. Cytokine expression was invariably a feature of microglial cells, except for IL-10, which was exclusively astrocytic. Oligodendrocytes did not display cytokines, except for low levels of IL-18. Although no pattern was specific for MS, most molecules were upregulated in MS and OND. Downstream JAK/STAT molecules were correspondingly upregulated. Cytokine receptors on oligodendrocytes (and microglia), and their corresponding ligands on microglia (and astrocytes), may implicate paracrine/autocrine regulation and may bespeak innate immunity in the central nervous system.

An integrative review of positive health practices.

This study presents an integrative review of published research articles on positive health practices (PHP) as defined by Muhlenkamp and Brown. Using Cooper's guidelines for accomplishing an integrative review, 29 relevant studies concerning PHP were located, reviewed, and critiqued; theoretical and methodological issues emerging from the studies were identified. Directions for future research on PHP are specified. Implications for nursing practice derived from the research findings are addressed.

Differential efficacy of a synthetic antagonist of VLA-4 during the course of chronic relapsing experimental autoimmune encephalomyelitis.

The integrin VLA-4 has been shown to play a key role in the entry of antigen-specific T cells into the CNS during autoimmune demyelination. Treatment of animals with experimental autoimmune encephalomyelitis (EAE), a model of multiple sclerosis, with antibodies to VLA-4 is known to suppress acute disease. In the present study, a synthetic antagonist of VLA-4 (TBC 3486) was injected subcutaneously into mice adoptively sensitized for chronic relapsing EAE. TBC 3486 was administered daily for 14 days at early (before acute signs) and late time points (during chronic disease). Early treatment led to marked delay in disease onset and reduction in clinical severity and demyelination. After termination of treatment, clinical severity remained lower than in controls for more than 1 week. TBC 3486-treated animals showing no clinical signs (at the height of disease in controls) displayed moderate levels of inflammation but little damage to myelin. Late administration of TBC 3486 to animals with chronic EAE had no effect clinically. Immunocytochemistry and Western blotting of CNS tissue from acutely treated animals supported a moderate shift toward a Th2-type cytokine profile after treatment. Thus, TBC 3486 effectively delayed and reduced the acute (but not chronic) phase of EAE, and this amelioration correlated with changes in the inflammatory molecule profile.