Self-care agency in two groups of pregnant women.

Self-care agency, a multidimensional concept in Orem's self-care deficit nursing theory, includes motivation, decision-making, energy, and knowledge necessary to perform self-care actions. Basic conditioning factors affect individuals' development and exercise of self-care agency. Secondary analysis of Appraisal of Self-Care Agency (ASA) scores in two groups of pregnant women, (1) a childbirth education group (n = 119) and (2) a clinic group (n = 127) was completed. Group 2 had significantly higher ASA scores. Several basic conditioning factors influenced ASA scores. Results offer implications for Orem's theory and maternity nursing practice.

Couples' attitudes toward childbirth participation: relationship to evaluation of labor and delivery.

The article reports a correlational, partial replication study investigating the relationship between couples' prenatal attitudes toward childbirth participation and perceptions of their labor and delivery experiences. The Prenatal Attitude toward Childbirth Participation Scale was administered to 119 couples before and after attendance at a childbirth education course. The Labor Delivery Evaluation Scale, the Labor Agency Scale, and the Delivery Agency Scale were administered after delivery. Results showed that childbirth education affected couples' anticipated levels of control during labor and delivery. Anticipated and perceived levels of control were associated, and perceived levels of control correlated with overall evaluations of childbirth experiences. These findings suggest that childbirth educators and health care providers should focus on participants' opportunities to exercise control during childbirth and on identifying emergency situations during which control must be relinquished to the health care team.

Interaction of polyacrylates with porcine pepsin and the gastric mucus barrier: a mechanism for mucosal protection.

1. The mechanism of interaction of the polyacrylates, carbopols with the mucus barrier in vivo has been investigated in vitro. 2. Carbopol caused a dramatic increase in the viscosity of porcine gastric mucin solutions that was up to 19-fold greater than that of the sum of the individual polymers. 3. The mucin-carbopol interaction was stable after an initial 30 min period for up to 36 h at 25 degrees C or 37 degrees C. It was reduced by increasing the temperature from 20 degrees C to 45 degrees C, was unaffected by pH and ionic strength, but was enhanced by Ca2+. 4. The magnitude of the interaction between mucin and carbopol depended on the polymeric structure of the mucin and the molecular size and level of cross-linking of the carbopol. 5. The interactions were reversible and increased with increasing carbopol and mucin concentration. The dramatic increase in viscosity can be explained in terms of space filling by the mucin molecules leading to predominantly carbopol-carbopol interactions. 6. Carbopol 934P inhibits pepsin hydrolysis and therefore has potential as a mucosal protective agent in vivo.

Laparoscopic presacral neurectomy for treatment of midline pelvic pain.

STUDY OBJECTIVE: To examine the efficacy and safety of laparoscopic presacral neurectomy (LPSN) as the initial surgical treatment of midline pelvic pain and dysmenorrhea; and to evaluate its effectiveness in conjunction with procedures to relieve lateral pelvic pain, such as excision of endometriosis and lysis of adhesions. DESIGN: A preoperative and postoperative self-rating with which patients classified pain on an ordinal scale of 0 to 5. A x^{2 analysis of the data was performed. SETTING: A private hospital in Savannah, Georgia. PATIENTS: Twenty-seven women, age 15 to 41 years, who experienced severe midline dysmenorrhea and/or pain; 12 also had significant lateral pain. INTERVENTIONS: Laparoscopic presacral neurectomy was the primary intervention. Other procedures, including lysis of adhesions, excision and vaporization of endometriosis, and appendectomy were completed as adjuncts to LPSN. MEASUREMENTS AND MAIN RESULTS: Ratings were completed by patients 5 to 35 months after surgery. Twenty-two women reported no midline pain, three had significant reduction of pain, and two had persistence of severe pain. Two of the 12 women with lateral pain reported that pain persisted. CONCLUSIONS: The LPSN is safe and effective as an initial surgical intervention for treating midline dysmenorrhea and pelvic pain, and when it is performed by experienced laparoscopic surgeons with adequate training.}

Mucolysis of the colonic mucus barrier by faecal proteinases: inhibition by interacting polyacrylate.

1. Mucolytic (mucus solubilizing) activity in human faeces has been characterized with both purified human and pig colonic mucin and shown to be mediated by proteolysis. 2. Mucolytic activity was demonstrated by: (i) a drop in mucin viscosity; (ii) a substantial reduction in mucin size, from polymer to degraded subunit, as assessed by Sepharose CL-2B gel filtration; (iii) formation of new N-terminal peptides. 3. Mucolytic activity was also followed in faecal extracts by its proteolytic activity using standard succinyl albumin substrate. Proteolysis extended over the pH range 4.5-11.0. Proteolysis was inhibited at pH 7.5 by soybean trypsin inhibitor and phenylmethanesulphonyl fluoride, suggesting the presence of serine proteinases. 4. The polyacrylate carbomer (934P) inhibited both mucolysis of pig colonic mucin and proteolysis of succinyl albumin. 5. Interaction between the polyacrylate (carbomer 934P) and purified human and pig colonic mucin was demonstrated by a marked synergistic increase in solution viscosity (360% above control). 6. The results demonstrate the presence of a mucolytic activity in the human colonic lumen that has the potential to degrade the mucus barrier, and that polyacrylates inhibit this mucolysis and interact to strengthen the colonic mucus barrier. Polyacrylates may therefore have therapeutic potential in inflammatory bowel disease where luminal proteolytic activity can be raised.

Mucus glycoprotein content of human cholesterol gallstones.

Cholesterol gallstones were obtained from patients undergoing cholecystectomy and the mucus glycoprotein extracted. The biliary mucus glycoprotein was separated from other contaminants by Sepharose 4B gel filtration and the PAS staining excluded volume used to estimate mucus glycoprotein content of the gallstones. Hexosamine and sialic acid analysis of the glycoprotein indicated it was compositionally similar to the human mucus glycoprotein from bile. The mucus glycoprotein content of the nine stones analysed individually varied between 0.75 and 2.3 mg (a 3-fold variation) (1.27 +/- 0.16 mg, mean +/- SEM), whereas stone weight varied between 0.076 and 5.885 g (a 77-fold variation) (1.27 +/- 0.63 g, mean +/- SEM). When a pool of smaller stones, average weight 47 mg, was extracted, only 1.73 mg of glycoprotein was isolated, an average of 0.01 mg/stone. Analysis of the mucus glycoprotein by gel filtration on Sepharose 2B showed the majority of the glycoprotein was excluded as is the case with the mucus glycoprotein in bile. These results are consistent with biliary mucus glycoprotein being involved in the initial stages of gallstone formation but not in subsequent growth.