Building international partnerships.

Health is a global concern. Although nursing is a global profession, most schools of nursing concentrate on teaching health exclusively within the context of their own nation. Sister-school partnerships that cross national boundaries are one way of extending the learning opportunities of faculties and students. An example of a 5-year partnership is described and analysed.

Posttraumatic stress disorder and pregnancy complications.

OBJECTIVE: To assess the associations between specific pregnancy complications and posttraumatic stress disorder based on neurobiologic and behavioral characteristics, using Michigan Medicaid claims data from 1994-1996. METHODS: Two thousand, two hundred nineteen female recipients of Michigan Medicaid who were of childbearing age had posttraumatic stress disorder on the basis of International Classification of Diseases, 9th Revision (ICD-9) codes. Twenty percent (n = 455) of those recipients and 30% of randomly selected comparison women with no mental health diagnostic codes (n = 638; P <.001) had ICD-9 diagnostic codes for pregnancy complications. We used multiple logistic regression to investigate associations between specific pregnancy complications and posttraumatic stress disorder, controlling for demographic and psychosocial variables. Obstetric complications were hypothesized based on high-risk behaviors and neurobiologic alterations in stress axis function in posttraumatic stress disorder. RESULTS: After controlling for demographic and psychosocial factors, women with posttraumatic stress disorder had higher odds ratios (ORs) for ectopic pregnancy (OR 1.7, 95% confidence interval [CI] 1.1, 2.8), spontaneous abortion (OR 1.9, 95% CI 1.3, 2.9), hyperemesis (OR 3.9, 95% CI 2.0, 7.4), preterm contractions (OR 1.4, 95% CI 1.1, 1.9), and excessive fetal growth (OR 1.5, 95% CI 1.0, 2.2). Hypothesized labor differences were not confirmed and no differences were found for complications not thought to be related to traumatic stress. CONCLUSIONS: Pregnant women with posttraumatic stress disorder might be at higher risk for certain conditions, and assessment and treatment for undiagnosed posttraumatic stress might be warranted for women with those obstetric complications. Prospective studies are needed to confirm present findings and to determine potential biologic mechanisms. Treatment of traumatic stress symptoms might improve pregnancy morbidity and maternal mental health.

Heteropolymerization of S, I, and Z alpha1-antitrypsin and liver cirrhosis.

The association between Z alpha1-antitrypsin deficiency and juvenile cirrhosis is well-recognized, and there is now convincing evidence that the hepatic inclusions are the result of entangled polymers of mutant Z alpha1-antitrypsin. Four percent of the northern European Caucasian population are heterozygotes for the Z variant, but even more common is S alpha1-antitrypsin, which is found in up to 28% of southern Europeans. The S variant is known to have an increased susceptibility to polymerization, although this is marginal compared with the more conformationally unstable Z variant. There has been speculation that the two may interact to produce cirrhosis, but this has never been demonstrated experimentally. This hypothesis was raised again by the observation reported here of a mixed heterozygote for Z alpha1-antitrypsin and another conformationally unstable variant (I alpha1-antitrypsin; 39Arg-->Cys) identified in a 34-year-old man with cirrhosis related to alpha1-antitrypsin deficiency. The conformational stability of the I variant has been characterized, and we have used fluorescence resonance energy transfer to demonstrate the formation of heteropolymers between S and Z alpha1-antitrypsin. Taken together, these results indicate that not only may mixed variants form heteropolymers, but that this can causally lead to the development of cirrhosis.

Early adolescents' sexual behaviors.

The purpose of this study was to analyze changes in early adolescents' intimate behaviors and the initiation of sexual intercourse over a one-year time period. The changes are interpreted within the context of recent progress in understanding the development of early adolescents. Public school students in sixth and ninth grades of selected schools in a midwestern industrial city were studied in two waves of data collection. A total of 106 students provided data for the second year, allowing comparisons of their Time 2 with their Time 1 responses. Five of eight intimate behaviors studied increased in frequency during the year. Also, the adolescents' perceived benefits of having sexual intercourse increased and perceived costs decreased during the follow-up year. Increases in the frequency of intimate behaviors but not changes in their perceptions of the benefits and costs predicted whether or not students had initiated sexual intercourse during the follow-up period. These findings support current understanding of early adolescence as a time of incremental learning about intimacy and about sexual relationships. The findings suggest that preventing early sexual intercourse may require understanding the specific behavioral competencies related to healthful development of intimacy. Pediatric nurses can be leaders in providing the necessary counseling and education to young adolescents, their families, and their communities.

Prevalence of abuse among pregnant women choosing certified nurse-midwife or physician providers.

Despite the fact that violence against women is a widespread problem in the United States, many providers do not routinely screen for it, particularly if the woman is not from a lower socioeconomic group. This was a secondary analysis of survey data from 940 antenatal women in private CNM and MD practices. Median annual income was $40,000 to $49,000 and mean schooling completed was 15 years. It was found that 91 (9.7%) had a history of previous abuse and eight (0.9%) were currently in an abusive relationship. Women with a previous history of abuse were found in the CNM caseloads at higher than expected levels. Annual income was predictive of women currently being abused, but not for women with past history. Abused women had on average less education than nonabused, with the most marked difference seen in women reporting current abuse. These results provide further evidence that the problem of abuse is not restricted to women of lower socioeconomic status. The finding that women with history of abuse were more likely to appear in CNM caseloads adds further support to the need for routine screening.